• 四川大學(xué)華西第二醫(yī)院麻醉科（成都 610041）;

目的 　探討分娩鎮(zhèn)痛的方法和藥物的選擇以及分娩鎮(zhèn)痛對(duì)產(chǎn)程、器械助產(chǎn)率、分娩方式及母兒的影響。
方法 　計(jì)算機(jī)檢索Cochrane 圖書(shū)館（2006年第4期）、MEDLINE（1978～2006.10）和中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)（1980～2006.10），查找與分娩鎮(zhèn)痛有關(guān)的系統(tǒng)評(píng)價(jià)、Meta分析等，獲取最佳證據(jù)用于臨床治療。
結(jié)果 　共檢索到8篇Cochrane系統(tǒng)評(píng)價(jià)和6篇Meta分析。分析結(jié)果表明，硬膜外分娩鎮(zhèn)痛會(huì)造成第二產(chǎn)程延長(zhǎng)、催產(chǎn)素使用量的增加、器械助產(chǎn)率增加以及產(chǎn)婦發(fā)熱，但不會(huì)造成第一產(chǎn)程的延長(zhǎng)，剖宮產(chǎn)率的增加。
結(jié)論 　硬膜外分娩鎮(zhèn)痛較其他鎮(zhèn)痛方法具有優(yōu)勢(shì)。

引用本文： 林雪梅,周 俊,唐昱英,馬玉姍. 分娩鎮(zhèn)痛的臨床證據(jù). 中國(guó)循證醫(yī)學(xué)雜志, 2006, 06(11): 843-846. doi: 復(fù)制

1. 李幼平. 主編. 循證醫(yī)學(xué). 第1版. 北京: 高等教育出版社; 2003. 20~21.
2. Somuah MA, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2006, Issue 4.
3. Hughes D, Simmons SW, Brown J. Combined spinal-epidural versus epidural analgesia in labour Cochrane Database of Systematic Reviews 2006, Issue 4.
4. Hedayati H, Parsons J, Crowthe CA. Rectal analgesia for pain from perineal trauma following childbirth The Cochrane Database of Systematic Reviews 2006, Issue 4.
5. Smith CA , CollinCT s, Cyna AM, et al. Complementary and alternative therapies for pain management in labour The Cochrane Database of Systematic Reviews 2006, Issue 4.
6. Cluett ER, Nikodem VC, McCandlish RE. Immersion in water in pregnancy, labour and birth.The Cochrane Database of Systematic Reviews 2006, Issue 4.
7. Hodnett ED, Downe S, Dwards N, et al. Home-like versus conventional institutional settings for birth Cochrane Database of Systematic Reviews 2006, Issue 4.
8. Elbourne D, Wiseman RA. Types of intra-muscular opioids for maternal pain relief in labour. The Cochrane Database of Systematic Reviews 2006, Issue 4.
9. Torvaldsen S, Roberts CL, Bell JC, et al. Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia The Cochrane Database of Systematic Reviews 2006, Issue 4.
10. Liu EH, Sia AT. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. BMJ, 2004;328(7453): 1410.
11. Sharma SK, McIntire DD, Wiley J, et al. Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women. Anesthesiology, 2004; 100(1): 142–148.
12. Writer WD, Stienstra R, Eddleston JM, et al. Neonatal outcome and mode of delivery after epidural analgesia for labour with ropivacaine and bupivacaine: a prospective meta-analysis. Br J Anaesth, 1998; 81: 713–717.
13. Halpern SH, Walsh V. Epidural ropivacaine versus bupivacaine for labor: a meta-analysis. Anesth Analg, 2003; 96(5): 1473–1479.
14. Bucklin BA, Chestnut DH, Hawkins JL. Intrathecal opioids versus epidural local anesthetics for labor analgesia: a meta-analysis. Reg Anesth Pain Med, 2002; 27(1): 23–30.
15. Reynolds F, Sharma SK, Seed PT. Analgesia in labour and fetal acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia. BJOG, 2002; 109(12): 1344–1353.
16. Li YP. Editor-in-Chief. Evidence-Based Medicine. 1st Edition. Beijing: Higher Education Press; 2003. 20–21.
  1. 1. 李幼平. 主編. 循證醫(yī)學(xué). 第1版. 北京: 高等教育出版社; 2003. 20~21.
  2. 2. Somuah MA, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2006, Issue 4.
  3. 3. Hughes D, Simmons SW, Brown J. Combined spinal-epidural versus epidural analgesia in labour Cochrane Database of Systematic Reviews 2006, Issue 4.
  4. 4. Hedayati H, Parsons J, Crowthe CA. Rectal analgesia for pain from perineal trauma following childbirth The Cochrane Database of Systematic Reviews 2006, Issue 4.
  5. 5. Smith CA , CollinCT s, Cyna AM, et al. Complementary and alternative therapies for pain management in labour The Cochrane Database of Systematic Reviews 2006, Issue 4.
  6. 6. Cluett ER, Nikodem VC, McCandlish RE. Immersion in water in pregnancy, labour and birth.The Cochrane Database of Systematic Reviews 2006, Issue 4.
  7. 7. Hodnett ED, Downe S, Dwards N, et al. Home-like versus conventional institutional settings for birth Cochrane Database of Systematic Reviews 2006, Issue 4.
  8. 8. Elbourne D, Wiseman RA. Types of intra-muscular opioids for maternal pain relief in labour. The Cochrane Database of Systematic Reviews 2006, Issue 4.
  9. 9. Torvaldsen S, Roberts CL, Bell JC, et al. Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia The Cochrane Database of Systematic Reviews 2006, Issue 4.
  10. 10. Liu EH, Sia AT. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. BMJ, 2004;328(7453): 1410.
  11. 11. Sharma SK, McIntire DD, Wiley J, et al. Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women. Anesthesiology, 2004; 100(1): 142–148.
  12. 12. Writer WD, Stienstra R, Eddleston JM, et al. Neonatal outcome and mode of delivery after epidural analgesia for labour with ropivacaine and bupivacaine: a prospective meta-analysis. Br J Anaesth, 1998; 81: 713–717.
  13. 13. Halpern SH, Walsh V. Epidural ropivacaine versus bupivacaine for labor: a meta-analysis. Anesth Analg, 2003; 96(5): 1473–1479.
  14. 14. Bucklin BA, Chestnut DH, Hawkins JL. Intrathecal opioids versus epidural local anesthetics for labor analgesia: a meta-analysis. Reg Anesth Pain Med, 2002; 27(1): 23–30.
  15. 15. Reynolds F, Sharma SK, Seed PT. Analgesia in labour and fetal acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia. BJOG, 2002; 109(12): 1344–1353.
  16. 16. Li YP. Editor-in-Chief. Evidence-Based Medicine. 1st Edition. Beijing: Higher Education Press; 2003. 20–21.