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目的评价硬膜外联用新斯的明用于分娩镇痛的有效性和安全性。方法检索Cochrane图书馆、PubMed、EMbase、万方数据库、中国知网、中国生物医学文献服务系统,检索时间均从建库到2011年9月,收集硬膜外联用新斯的明用于分娩镇痛与单纯使用局麻药和(或)阿片类药比较的随机对照试验。由2名评价员独立评价文献,对符合入选标准的研究用RevMan 5.1.4软件进行meta分析。对连续变量以均数差(MD)及其95%置信区间(CI)分析统计量;对二分类变量以相对危险度及其95%CI分析统计量。结果共纳入4篇文献,其中2篇英文,2篇中文,包括282例患者。分析结果显示:硬膜外联用新斯的明与单纯使用局麻药和(或)阿片类药相比,其产妇疼痛视觉模拟评分较低,差异有统计学意义[低剂量组(1～2μg/kg或250μg):MD=-1.45,95%CI(-2.84,-0.07),P=0.04;中等剂量组(4μg/kg或500μg):MD=-2.35,95%CI(-3.69,-1.02),P=0.000 6;高剂量组(6～7μg/kg或750μg):MD=-21,95%CI(-36.31,-5.69),P=0.007];而在产程、剖宫产率或器械助产率、产妇恶心呕吐发生率及胎儿Apgar评分等方面,两组差异均无统计学意义。结论硬膜外联用新斯的明与单纯使用局麻药和(或)阿片类药物相比较,可增强分娩镇痛的效果,并且不增加不良反应发生率。
Objective To evaluate the efficacy and safety of epidural in combination with neostigmine for labor analgesia. Methods The Cochrane Library, PubMed, EMbase, Wanfang Database, CNKI, and China Biomedical Literature Service were searched from the database to September 2011. Epidural and neostigmine were collected for delivery Analgesia versus simple use of local anesthetics and / or opioids compared randomized controlled trials. Two reviewers independently rated the literature and conducted meta-analyzes using RevMan 5.1.4 for studies that met the inclusion criteria. Statistical analyzes were performed on continuous variables in mean difference (MD) and 95% confidence intervals (CI); for the dichotomous variables, relative risk and 95% CI were used to analyze the statistics. Results A total of 4 articles were included, including 2 English and 2 Chinese, including 282 patients. Analysis of the results showed that the epidural neostigmine visual acuity score of maternal pain was lower than the simple use of local anesthetics and / or opioids, the difference was statistically significant [low dose group (1 ~ 2μg / kg or 250μg): MD = -1.45,95% CI (-2.84, -0.07), P = 0.04; medium dose group (4μg / kg or 500μg): MD = -2.35,95% CI 1.06), P = 0.0006; high dose group (6-7μg / kg or 750μg): MD = -21,95% CI (-36.31, -5.69), P = 0.007] Or instrument midwifery rate, the incidence of maternal nausea and vomiting and fetal Apgar score, the two groups showed no significant difference. Conclusion Epidural use of neostigmine and local anesthetics alone and / or opiates can enhance labor analgesia without increasing the incidence of adverse reactions.