不同神经轴痛解疗法对医生在分娩过程中的干预需要的影响:一个网络的元分析
Lizhong Wang1, Jiayue Huang, Xiangyang Chang
1From the Department of Anesthesiology, Jiaxing Maternity and Children Healthcare Hospital, Affiliated Women and Children Hospital of Jiaxing University, Jiaxing, Zhejiang, China (LW, JH, XC, FX).
European journal of anaesthesiology
|March 28, 2024
概括
与患者控制的外周止痛疗法 (PCEA) 相结合的编程间歇性外周止痛 (PIEB) 与与PCEA连续外周输液 (CEI) 相比,减少了医生对分娩止痛的干预. 持续刺穿外周 (DPE) 或与PIEB+PCEA结合的脊髓外周 (CSE) 显示出更少干预的希望.
科学领域:
- 产科和妇科 产科和妇科
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
背景情况:
- 神经轴分娩止痛包括外围注射 (EPL),联合脊柱外围注射 (CSE) 和持续穿刺外围注射 (DPE) 技术.
- 维护方案包括连续外围注射 (CEI),患者控制的外围止痛 (PCEA) 和编程间歇性外围注射 (PIEB).
- 劳动止痛的最佳方式仍在争论中,特别是医生干预的必要性.
研究的目的:
- 为了比较不同神经轴分娩镇痛方式的有效性.
- 评估需要医生干预的妇女比例,以缓解不充分的疼痛.
- 确定哪些神经轴技术可以最大限度地减少对额外外外科医生管理的外围注射补充的需求.
主要方法:
- 随机对照试验的贝叶斯网络元分析.
- 在1988年至2023年期间搜索了多个数据库 (PubMed,Embase,CENTRAL,Web of Science,Wanfang Data).
- 包括比较六种神经轴痛解组合的试验 (例如,EPL+CEI+PCEA,CSE+PIEB+PCEA,DPE+PIEB+PCEA).
主要成果:
- 分析了30项涉及8188名女性的研究.
- 与 PCEA 进行的编程间歇性外围注射 (PIEB) 与 PCEA 进行的连续外围注射 (CEI) 相比,显著减少了医生干预.
- 持续刺穿外周 (DPE) 或结合脊柱外周 (CSE) 与PIEB+PCEA结合显示,需要干预的女性比例最低.
结论:
- PIEB+PCEA与CEI+PCEA在分娩期间医生干预的风险较低.
- 与其他方法相比,DPE或CSE与PIEB+PCEA相结合可能会减少医生干预.
- 较新的神经轴技术可能不会比传统技术提供实质性的优势;由于数据限制,建议谨慎使用.
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