硬膜外罗哌卡因与左旋布比卡因分娩镇痛对产妇和胎儿结局的影响:一项荟萃分析。

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
Zhen Li, Xinxing Zhou, Hailin Wang
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引用次数: 0

摘要

导言:用于硬膜外镇痛的新型神经局部麻醉剂已证明可在分娩过程中提供可靠的镇痛效果。罗哌卡因和左旋布比卡因是目前用于分娩镇痛的新型药物。然而,尽管很少有研究将罗哌卡因和左布比卡因与布比卡因进行比较,但也很少对它们进行系统的比较。因此,在本分析中,我们旨在系统地展示硬膜外罗哌卡因与左旋布比卡因分娩镇痛对产妇和胎儿结局的影响。方法:http://www.Clinicaltrials: gov、Web of Science、MEDLINE、EMBASE、Cochrane数据库和谷歌学术搜索了罗哌卡因与左旋布比卡因分娩镇痛的比较研究。产妇和胎儿的结局被视为本次分析的终点。本研究使用 RevMan 软件 5.4 分析数据。分析后的数据采用风险比(RR)和95%置信区间(CI)表示:共有 2062 名参与者参与了此次分析,其中 1054 名参与者被分配到罗哌卡因,1008 名参与者被分配到左布比卡因。该分析的主要结果显示,与左旋布比卡因相比,硬膜外罗哌卡因用于分娩镇痛时发生低血压(RR:0.71,95% CI:0.43 - 1.17;P = 0.18)和瘙痒(RR:1.12,95% CI:0.89 - 1.42;P = 0.34)的风险并无明显增加。然而,罗哌卡因发生恶心和呕吐的风险明显更高(RR:1.60,95% CI:1.05 - 2.44;P = 0.03)。自然阴道分娩(RR:0.99,95% CI:0.89 - 1.42;P = 0.83)、器械阴道分娩(RR:1.13,95% CI:0.89 - 1.45;P = 0.32)和剖宫产风险(RR:0.76,95% CI:0.42 - 1.37;P = 0.35)没有明显差异。在对胎儿结局进行评估时,Apgar 评分结论为 "胎儿健康":总之,我们的分析表明,就母体和胎儿结局而言,硬膜外罗哌卡因和左旋布比卡因对分娩镇痛同样有效。本分析未观察到对产妇和胎儿有重大不利影响的结果。然而,考虑到该分析的一些局限性,进一步的大型研究应能解决并澄清这一问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The impact of epidural ropivacaine versus levobupivacaine for labor analgesia on maternal and fetal outcomes: a meta-analysis.

Introduction: Newer neuraxial local anesthetic agents which have been used as epidural analgesia have shown to provide reliable pain relief during labor. Ropivacaine and levobupivacaine are newer agents now used for labor analgesia. However, even though few studies have made their comparison with bupivacaine, ropivacaine and levobupivacaine have seldom systematically been compared. Therefore, in this analysis, we aimed to systematically show the impact of epidural ropivacaine versus levobupivacaine for labor analgesia on maternal and fetal outcomes.

Methods: http://www.

Clinicaltrials: gov , Web of Science, MEDLINE, EMBASE, Cochrane database and Google Scholar were searched for studies comparing ropivacaine versus levobupivacaine for labor analgesia. Maternal and fetal outcomes were considered as the endpoints in this analysis. The RevMan software 5.4 was used to analyze data in this study. Risk ratio (RR) with 95% confidence intervals (CI) were used to represent the data post analysis.

Results: A total number of 2062 participants were included in this analysis whereby 1054 participants were assigned to ropivacaine and 1008 participants were assigned to levobupivacaine. The main results of this analysis showed that epidural ropivacaine was not associated with significantly higher risk of hypotension (RR: 0.71, 95% CI: 0.43 - 1.17; P = 0.18) and pruritus (RR: 1.12, 95% CI: 0.89 - 1.42; P = 0.34) when compared to levobupivacaine for labor analgesia. However, the risk of nausea and vomiting was significantly higher with ropivacaine (RR: 1.60, 95% CI: 1.05 - 2.44; P = 0.03). Spontaneous vaginal delivery (RR: 0.99, 95% CI: 0.89 - 1.42; P = 0.83), instrumental vaginal delivery (RR: 1.13, 95% CI: 0.89 - 1.45; P = 0.32) and the risk for cesarean section (RR: 0.76, 95% CI: 0.42 - 1.37; P = 0.35) were not significantly different. When fetal outcomes were assessed, Apgar score < 7 at 1 min (RR: 1.01: 95% CI: 0.57 - 1.80; P = 0.97), abnormality of fetal heart rate (RR: 1.45, 95% CI: 0.55 - 3.79; P = 0.45) and neonatal asphyxia (RR: 0.35, 95% CI: 0.10 - 1.18; P = 0.09) were also similarly manifested.

Conclusions: To conclude, our analysis showed both epidural ropivacaine and levobupivacaine to be equally effective for labor analgesia in terms of maternal and fetal outcomes. No major adverse maternal and fetal outcome was observed in this analysis. However, considering the several limitations of this analysis, further larger studies should be able to solve and clarify this issue.

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来源期刊
BMC Anesthesiology
BMC Anesthesiology ANESTHESIOLOGY-
CiteScore
3.50
自引率
4.50%
发文量
349
审稿时长
>12 weeks
期刊介绍: BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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