分娩镇痛的临床证据

Clincal Evidence of Analgesia During Labor

目的探讨分娩镇痛的方法和药物的选择以及分娩镇痛对产程、器械助产率、分娩方式及母儿的影响。方法计算机检索Cochrane图书馆(2006年第4期)、MEDLINE (1978-2006．10)和中国生物医学文献数据库(1980-2006．10),查找与分娩镇痛有关的系统评价、Meta分析等,获取最佳证据用于临床治疗。结果共检索到8篇Cochrane系统评价和6篇Meta分析。分析结果表明,硬膜外分娩镇痛会造成第二产程延长、催产素使用量的增加、器械助产率增加以及产妇发热,但不会造成第一产程的延长,剖宫产率的增加。结论硬膜外分娩镇痛较其他镇痛方法具有优势。

Objective To assess the effects on labour, maternal, and neonatal outcomes of different techniques and drugs for analgesia during labour. Methods We searched The Cochrane Library （Issue 4, 2006）, MEDLINE （Jan. 1978 to Oct, 2006） and CBMdisc （Jan. 1980 to Oct. 2006） to collect the current best evidence of labor analgesia. Results We included eight Cochrane systematic reviews and six other meta-analyses. The evidence showed that epidural analgesia was associated with a longer second stage of labour, more frequent oxytocin augmentation, higher incidence of instrumental vaginal delivery and maternal fever. But it was unlikely to increase the risk of caesarean section. Conclusion Epidural analgesia is superior to other approaches.