目的 系統(tǒng)評(píng)價(jià)瑞芬太尼用于全身麻醉下剖宮產(chǎn)時(shí)對(duì)新生兒的影響。 方法 檢索Cochrane Library、PubMed、OVID、EMbase、CNKI、萬(wàn)方等中外數(shù)據(jù)庫(kù)，收集1990年－2012年關(guān)于瑞芬太尼用于全身麻醉下剖宮產(chǎn)的臨床隨機(jī)對(duì)照研究。按Cochrane系統(tǒng)評(píng)價(jià)方法評(píng)估文獻(xiàn)質(zhì)量，用Revman 5.1軟件對(duì)提取的數(shù)據(jù)進(jìn)行Meta分析。 結(jié)果 共納入10項(xiàng)研究，包括342例產(chǎn)婦。與空白對(duì)照組相比，瑞芬太尼降低新生兒1 min Apgar評(píng)分[WMD=?0.46，95%CI（?0.65，?0.27），P＜0.000 01]，提高出生時(shí)臍動(dòng)脈pH值[WMD=0.01，95%CI（0.00，0.02），P=0.004]，增加出生時(shí)窒息發(fā)生率[RR=1.76，95%CI（1.06，2.95），P=0.03]；當(dāng)誘導(dǎo)劑量為1.0～1.5 μg/kg時(shí)，對(duì)5 min Apgar評(píng)分無(wú)影響[WMD=?0.14，95%CI（?0.32，0.04），P=0.13]。 結(jié)論 瑞芬太尼用于全身麻醉剖宮產(chǎn)可減輕新生兒酸中毒，但是會(huì)對(duì)新生兒產(chǎn)生一過(guò)性的呼吸抑制。
引用本文： 顧娟,陳杰,陳元敬,劉斌. 瑞芬太尼用于全身麻醉剖宮產(chǎn)對(duì)新生兒影響的Meta分析. 華西醫(yī)學(xué), 2012, 27(9): 1361-1365. doi: 復(fù)制
| 1. | Rittmaster RS, Cutler Jr GB, Sobel DO, et al. Morphine inhibits the pituitary-adrenal response to ovine corticotropinreleasing hormone in normal subjects[J]. J Clin Endocrinol Metab, 1985, 60(5): 891-895. |
| 2. | Kan RE, Hughes SC, Rosen MA, et al. Intravenous remifentanil: placental transfer, maternal and neonatal effects[J]. Anesthesiology, 1998, 88(6): 1467-1474. |
| 3. | Draisci G, Valente A, Suppa E, et al. Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial[J]. Int J Obstet Anesth, 2008, 17(2): 130-136. |
| 4. | Ngan Kee WD, Khaw KS, Ma KC, et al. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial[J]. Anesthesiology, 2006, 104(1): 14-20. |
| 5. | Yoo KY, Jeong CW, Park BY, et al. Effects of remifentanil on cardiovascular and bispectral index responses to endotracheal intubation in severe pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia[J]. Br J Anaesth, 2009, 102(6): 812-819. |
| 6. | 趙娜, 李有長(zhǎng). 瑞芬太尼在剖宮產(chǎn)麻醉中應(yīng)用的研究[J]. 重慶醫(yī)學(xué), 2006, 35(21): 1976-1977. |
| 7. | 陳皆鋒, 張新民, 丁潔嵐, 等. 瑞芬太尼復(fù)合異丙酚用于剖宮產(chǎn)術(shù)產(chǎn)婦全麻的臨床效果觀察[J]. 安徽醫(yī)藥, 2006, 10(2): 102-103. |
| 8. | 劉琳, 嚴(yán)海雅. 瑞芬太尼用于剖宮產(chǎn)術(shù)全身麻醉對(duì)母嬰的影響[J]. 現(xiàn)代實(shí)用醫(yī)學(xué), 2010, 22(6): 668-669. |
| 9. | Park BY, Yoo KY, Lee MK, et al. Maternal and neonatal effects of remifentanil used during induction of general anesthesia in preeclamptic patients undergoing cesarean delivery[J]. Korean J Anesthesiol, 2009, 57(1): 62-68. |
| 10. | 曾葵, 楊瑩瑩, 黃瀚, 等. 剖宮產(chǎn)全麻誘導(dǎo)使用瑞芬太尼對(duì)新生兒的影響[J]. 四川大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2009, 40(4): 755-757. |
| 11. | Bouattour L, Ben Amar H, Bouali Y, et al. Maternal and neonatal effects of remifentanil for general anaesthesia for Caesarean delivery[J]. Ann Fr Anesth Reanim, 2007, 26(4): 299-304. |
- 1. Rittmaster RS, Cutler Jr GB, Sobel DO, et al. Morphine inhibits the pituitary-adrenal response to ovine corticotropinreleasing hormone in normal subjects[J]. J Clin Endocrinol Metab, 1985, 60(5): 891-895.
- 2. Kan RE, Hughes SC, Rosen MA, et al. Intravenous remifentanil: placental transfer, maternal and neonatal effects[J]. Anesthesiology, 1998, 88(6): 1467-1474.
- 3. Draisci G, Valente A, Suppa E, et al. Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial[J]. Int J Obstet Anesth, 2008, 17(2): 130-136.
- 4. Ngan Kee WD, Khaw KS, Ma KC, et al. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial[J]. Anesthesiology, 2006, 104(1): 14-20.
- 5. Yoo KY, Jeong CW, Park BY, et al. Effects of remifentanil on cardiovascular and bispectral index responses to endotracheal intubation in severe pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia[J]. Br J Anaesth, 2009, 102(6): 812-819.
- 6. 趙娜, 李有長(zhǎng). 瑞芬太尼在剖宮產(chǎn)麻醉中應(yīng)用的研究[J]. 重慶醫(yī)學(xué), 2006, 35(21): 1976-1977.
- 7. 陳皆鋒, 張新民, 丁潔嵐, 等. 瑞芬太尼復(fù)合異丙酚用于剖宮產(chǎn)術(shù)產(chǎn)婦全麻的臨床效果觀察[J]. 安徽醫(yī)藥, 2006, 10(2): 102-103.
- 8. 劉琳, 嚴(yán)海雅. 瑞芬太尼用于剖宮產(chǎn)術(shù)全身麻醉對(duì)母嬰的影響[J]. 現(xiàn)代實(shí)用醫(yī)學(xué), 2010, 22(6): 668-669.
- 9. Park BY, Yoo KY, Lee MK, et al. Maternal and neonatal effects of remifentanil used during induction of general anesthesia in preeclamptic patients undergoing cesarean delivery[J]. Korean J Anesthesiol, 2009, 57(1): 62-68.
- 10. 曾葵, 楊瑩瑩, 黃瀚, 等. 剖宮產(chǎn)全麻誘導(dǎo)使用瑞芬太尼對(duì)新生兒的影響[J]. 四川大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2009, 40(4): 755-757.
- 11. Bouattour L, Ben Amar H, Bouali Y, et al. Maternal and neonatal effects of remifentanil for general anaesthesia for Caesarean delivery[J]. Ann Fr Anesth Reanim, 2007, 26(4): 299-304.