Naloxone for Cardio - Pulmonary - Cerebral Resuscitation: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

DENG Jia , LI Qian ,  LIU Bin

Department of Anesthesiology, West China Hostital, Sichuan University, Chengdu 610041,China;

Corresponding author：

LIU Bin, Email: dengjia2001519@163.com

Keywords：

Naloxone; CPCR; Randomized controlled trials; Systematic review; Meta-analysis

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To assess the efficacy of naloxone for cardio-pulmonary-cerebral resuscitation (CPCR).
Methods 　Randomized controlled trials (RCTs) involving naloxone for CPCR were identified from MEDLINE (1966 – Jun.2006), EMbase (1974 - Jun.2006), PubMed, The Cochrane Library (Issue2,2006), CBM(1978 - Jun.2006) and CNKI (1994 - Jun.2006). The quality of the trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by the Cochrane Collaboration was used for statistical analysis.
Results 　Ten RCTs were included. The quality of included RCTs was low. All the patients were in-patients or out-patients receiving CPCR due to cardial arrest at the age of 18-75 years. Meta-analysis indicated that the resuscitation rate in naloxone group was significantly higher than the placebo group (P lt;0.00001). And the recovery of the brain function in naloxone group was better than in the placebo group(P lt;0.00001)
Conclusions 　Naloxone is effective for CPCR and it may ameliorate its prognosis. Because of the low quality of included trials and the small sample size, more RCTs are required to assess the efficacy of naloxone for CPCR.

Citation： DENG Jia,LI Qian,LIU Bin. Naloxone for Cardio - Pulmonary - Cerebral Resuscitation: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(11): 820-825. doi: Copy

1.	庄心良, 曾因明, 陈伯銮. 主编. 现代麻醉学. 第3版. 北京: 人民卫生出社; 2004. 2306~2311.
2.	陈克田, 李明亭. 内啡肽与纳洛酮. 见: 孟庆林. 主编. 纳洛酮的基础研究与临床应用. 北京: 经济日报出版社; 1996. 209.
3.	靳伟民, 韩树堂. 盐酸纳洛酮治疗颅脑损伤合并呼吸骤停 (附49例报告). 急诊医学, 1997; 6(): 339.
4.	邵孝. 心肺脑复苏. 见: 邵孝, 蒋朱明. 主编. 急诊医学. 上海: 上海科学技术出版社; 1992. 55~69.
5.	孟庆林, 胡长欣, 候延奎. 盐酸纳洛酮拮抗乙醇中毒作用机理的探讨. 中国急救医学, 1996; 16(): 2.
6.	杨天德, 刘桥义, 陈意生, 等. 纳洛酮对缺血再灌注心肌超微结构的影响. 见: 孟庆林. 主编. 纳洛酮的基础研究与临床应用. 北京: 经济日报出版社; 1996. 6~8.
7.	陈天铎, 董晨明, 李培杰, 等. 纳洛酮对心肺脑复苏作用的评价. 急诊医学, 2000; (1): 5~7.
8.	李婷, 吴岩. 纳络酮用于心肺脑复苏24例疗效观察. 吉林大学学报•医学版, 2004; 30(5): 768.
9.	姚品安, 宋秀琴. 纳洛酮在心肺脑复苏中的疗效观察. 中国实用医学研究杂志, 2004; 3(6): 507~508.
10.	车海明. 纳洛酮在急性中毒心肺复苏中的应用. 中华临床医药杂志, 2004; 5(2): 94.
11.	罗宝权, 黄崇军, 吴宗波, 等．纳洛酮联合肾上腺素进行心肺复苏. 临床荟萃, 2003; 18(9): 523~524.
12.	郭美华, 任景艳, 赵莉. 纳洛酮联合肾上腺素进行心肺复苏的疗效观察. 实用医技杂志, 2005; 12(2B): 459.
13.	刘秀娟, 余胜利. 纳洛酮对心肺脑复苏的临床疗效观察. 贵州医药, 2002; 26(1): 40~41.
14.	林翔, 郑伟, 朱宏刚. 盐酸纳洛酮在心肺脑复苏急诊抢救中的应用. 中国厂矿医学, 2006; 19(1): 18~19.
15.	赵林明, 张兆顺, 刘玉桥. 纳洛酮治疗呼吸心搏骤停患者临床观察. 现代中西医结合杂志, 2006; 15(5): 584~585.
16.	王云峰, 王瑞斌. 纳络酮在脑复苏中的疗效观察. 基层医学论坛, 2004; 8(1): 43.
17.	郭美华, 任景艳, 赵莉. 纳洛酮联合肾上腺素心肺复苏33例疗效观察. 中华全科医师杂志, 2005; 4(9): 553.
18.	憔天铎, 董晨明, 李培杰, 等. 心肺脑复苏期间应用纳洛酮临床价值的探讨. 甘肃科技, 1999; (4).
19.	董晨明, 陈天铎, 李培杰. 纳洛酮在呼吸复苏中的临床应用. 中国医刊, 2000; 35(11): 49.
20.	董晨明, 李侠, 张京梅. 在心肺脑复苏中纳洛酮的临床应用体会. 伤残医学杂志, 2000; 8(3): 38~40.
21.	陈天铎, 董晨明, 李培杰. 纳络酮用于心肺脑复苏21例疗效观察. 中国危重病急救医学, 2001; 13(3): 182.
22.	高超, 刘建中. 心肺复苏中联合应用肾上腺素与纳洛酮的研究. 宁夏医学杂志, 2004; 26(11): 680~682.
23.	王伟强, 沈建妹, 陈淑叶. 大剂量纳洛酮心肺复苏疗效分析. 中国综合临床, 2003; 19(11): 989~990.
24.	崔小锋. 常规心肺复苏加用纳洛酮救治心脏骤停体会. 右江民族医学院学报, 2000; (3): 403~404.
25.	马玉英, 杜广胜, 杨晚青, 等. 盐酸纳洛酮在脑复苏中的疗效观察. 农垦医学, 2000; 22(2): 91.
26.	曹秋菊, 孙瑞林. 纳洛酮用于心脑肺复苏术31例临床分析. 镇江医学院学报, 1999; 9(2): 229.
27.	Zhuang XL, Zeng YM, Chen BL. Editor-in-chief. Modern Anesthesiology. 3rd ed. Beijing: People’s Medical Publishing House; 2004. 2306–2311.
28.	Chen KT, Li MT. Endogenous opioid and naloxone. In: Meng QL. Editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 209.
29.	Le WM, Han ST. Effect of naloxone on craniocerebral injury and apnoea. Journal of Emergency Medicine, 1997; 6(): 339.
30.	Shao X. Cardiopulmonary-cerebral Resuscitation. In: Shao X. Jiang ZM. editor-in-chief. Shanghai: Shanghai Science and Technique Press; 1992. 55–69.
31.	Lou HC, Tweed WA, Davis JM. Preferential blood flow increase tothe brain stem in moderate neonatal hypoxia: reyersal by naloxone. EurJ Pediatr, 1985; 144(): 225.
32.	Meng QL, Hu CX, Hou YK. Mechanism of antagonism of naloxone to ethanol. Chinese Journal of Critical Care Medicine, 1996; 16(): 2.
33.	Yang TD, Liu QY, Cheng YS, et al. Effect of naloxone for ultrastructure of ischemia reperfusion cardiac muscle. In: Meng QL. editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 6–8.
34.	Hughes GS. Naloxone and methylprednisolone sodium succinate enhance sympathomedullary discharge in patients with septic shock. Life sci, 1984; 35(): 2319.
35.	Mcintosh TK. Effect of an opiate antagonist (naloxone) and agonist/ an2tagonist (nalbuphine) in primate hemorrhagic shock : relationship to cat2echolaminer elease. Cire shock, 1985; 17(): 313.
36.	McGuire W, Fowlie PW. Naloxone for narcotic exposed newborn infants: systematic review. Archives of Disease in Childhood Fetal & Neonatal Edition, 2003; 88(4): F308–F311.
37.	Cheng TD, Dong CM, Li PJ, et al. Clinical study on the administration of naloxone during closed-chest cardiopulmonary-cerebral resuscitation. Journal of Emergency Medicine, 2000; (1): 5–7.
38.	Li T, Wu Y. Efficacy evaluation of naloxone in 24 cases of cardiopulmonary-cerebral resuscitation. Journal of Jilin University (Medicine Edition), 2004; 30(5): 768.
39.	Yao PA, Song XQ. Clinical efficacy on the administration of naloxone during cardiopulmonary-cerebral resuscitation. Chinese Research Journal of Practical Medicine, 2004; 3(6): 507–508.
40.	Che HM. Application of naloxone during cardiopulmonary resuscitation after acute toxicosis. Chinese Clinical Medicine, 2004; 5(2): 94.
41.	Luo BQ, Huang CJ, Wu ZB, et al. Naloxone combined with adrenaline for cardiopulmonary resuscitation. Clinical Focus, 2003; 18(9): 523–524.
42.	Guo MH, Ren JY, Zhao L. Effect of Naloxone combined with adrenaline for cardiopulmonary resuscitation. Journal of Practical Medical Techniques, 2005; 12(2B): 459.
43.	Liu XJ, Yu SL. Efficacy evaluation of naloxone for cardiopulmonary-cerebral resuscitation. Guizhou Medical Journal, 2002; 26(1): 40–41.
44.	Lin X, Zheng W, Zhu HG. Application of naloxone in cardiopulmonary-cerebral resuscitation. Chinese Medicine of Factory and Mine, 2006; 19(1): 18–19.
45.	Zhao LM, Zhang ZS, Liu YQ. Clinical observation of naloxone for cardiac arrest. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2006; 15(5): 584–585.
46.	Wang XF, Wang RB. Clinical efficacy of naloxone for cerebral resuscitation. Medical Forums in Basic, 2004; 8(1): 43.
47.	Guo MH, Ren JY, Zhao L. Clinical efficacy of naloxone combined with adrenaline for 33 cardiopulmonary-cerebral resuscitation cases. Chinese Journal of General Practitioners, 2005; 4(9): 553.
48.	Chen TZ, Dong CM, Li PJ, et al. Clinical efficacy of the administration of naloxone during cardiopulmonary-cerebral resuscitation. Gansu Science and Technology, 1999; (4).
49.	Dong CM, Chen TZ, Li PJ. Clinical application of naloxone in cardiopulmonary resuscitation. Chinese Journal of Medicine, 2000; 35(11): 49.
50.	Dong CM, Li X, Zhang JM. Clinical study on administration of naloxone during closed-chest cardiopulmonary-cerebral resuscitation. Medical Journal of Trauma and Disability, 2000; 8(3): 38–40.
51.	Chen TZ, Dong CM, Li PJ. Efficacy evaluation of naloxone in 21 cases of cardiopulmonary-cerebral resuscitation. Chinese Critical Care Medicine, 2001; 13(3): 182.
52.	Gao C, Liu JZ. Study of applying of epinephrine with naloxone hydrochloride to patients during cardiopulmonary resuscitation. Ningxia Medical Journal, 2004; 26(11): 680–682.
53.	Wang WQ, Shen JM, Chen SY. Efficacy evaluation of large dose naloxone for cardiopulmonary-cerebral resuscitation. Clinical Medicine of China, 2003; 19(11): 989–990.
54.	Cui XF. Naloxone combined with routine cardiopulmonary resuscitation for cardiac arrest. Journal of Youjiang Medical College For Nationalities, 2000; (3): 403–404.
55.	Ma YY, Du GS, Yang WQ, et al. Efficacy evaluation of naloxone for cerebral resuscitation. Agricultural Reclamation Medicine, 2000; 22(2): 91.
56.	Cao QJ, Sun RL. Clinical analysis of naloxone in 31 cases of cardiopulmonary-cerebral resuscitation. Journal of Zhenjiang Medical College, 1999; 9(2): 229.

1. 庄心良, 曾因明, 陈伯銮. 主编. 现代麻醉学. 第3版. 北京: 人民卫生出社; 2004. 2306~2311.
2. 陈克田, 李明亭. 内啡肽与纳洛酮. 见: 孟庆林. 主编. 纳洛酮的基础研究与临床应用. 北京: 经济日报出版社; 1996. 209.
3. 靳伟民, 韩树堂. 盐酸纳洛酮治疗颅脑损伤合并呼吸骤停 (附49例报告). 急诊医学, 1997; 6(): 339.
4. 邵孝. 心肺脑复苏. 见: 邵孝, 蒋朱明. 主编. 急诊医学. 上海: 上海科学技术出版社; 1992. 55~69.
5. 孟庆林, 胡长欣, 候延奎. 盐酸纳洛酮拮抗乙醇中毒作用机理的探讨. 中国急救医学, 1996; 16(): 2.
6. 杨天德, 刘桥义, 陈意生, 等. 纳洛酮对缺血再灌注心肌超微结构的影响. 见: 孟庆林. 主编. 纳洛酮的基础研究与临床应用. 北京: 经济日报出版社; 1996. 6~8.
7. 陈天铎, 董晨明, 李培杰, 等. 纳洛酮对心肺脑复苏作用的评价. 急诊医学, 2000; (1): 5~7.
8. 李婷, 吴岩. 纳络酮用于心肺脑复苏24例疗效观察. 吉林大学学报•医学版, 2004; 30(5): 768.
9. 姚品安, 宋秀琴. 纳洛酮在心肺脑复苏中的疗效观察. 中国实用医学研究杂志, 2004; 3(6): 507~508.
10. 车海明. 纳洛酮在急性中毒心肺复苏中的应用. 中华临床医药杂志, 2004; 5(2): 94.
11. 罗宝权, 黄崇军, 吴宗波, 等．纳洛酮联合肾上腺素进行心肺复苏. 临床荟萃, 2003; 18(9): 523~524.
12. 郭美华, 任景艳, 赵莉. 纳洛酮联合肾上腺素进行心肺复苏的疗效观察. 实用医技杂志, 2005; 12(2B): 459.
13. 刘秀娟, 余胜利. 纳洛酮对心肺脑复苏的临床疗效观察. 贵州医药, 2002; 26(1): 40~41.
14. 林翔, 郑伟, 朱宏刚. 盐酸纳洛酮在心肺脑复苏急诊抢救中的应用. 中国厂矿医学, 2006; 19(1): 18~19.
15. 赵林明, 张兆顺, 刘玉桥. 纳洛酮治疗呼吸心搏骤停患者临床观察. 现代中西医结合杂志, 2006; 15(5): 584~585.
16. 王云峰, 王瑞斌. 纳络酮在脑复苏中的疗效观察. 基层医学论坛, 2004; 8(1): 43.
17. 郭美华, 任景艳, 赵莉. 纳洛酮联合肾上腺素心肺复苏33例疗效观察. 中华全科医师杂志, 2005; 4(9): 553.
18. 憔天铎, 董晨明, 李培杰, 等. 心肺脑复苏期间应用纳洛酮临床价值的探讨. 甘肃科技, 1999; (4).
19. 董晨明, 陈天铎, 李培杰. 纳洛酮在呼吸复苏中的临床应用. 中国医刊, 2000; 35(11): 49.
20. 董晨明, 李侠, 张京梅. 在心肺脑复苏中纳洛酮的临床应用体会. 伤残医学杂志, 2000; 8(3): 38~40.
21. 陈天铎, 董晨明, 李培杰. 纳络酮用于心肺脑复苏21例疗效观察. 中国危重病急救医学, 2001; 13(3): 182.
22. 高超, 刘建中. 心肺复苏中联合应用肾上腺素与纳洛酮的研究. 宁夏医学杂志, 2004; 26(11): 680~682.
23. 王伟强, 沈建妹, 陈淑叶. 大剂量纳洛酮心肺复苏疗效分析. 中国综合临床, 2003; 19(11): 989~990.
24. 崔小锋. 常规心肺复苏加用纳洛酮救治心脏骤停体会. 右江民族医学院学报, 2000; (3): 403~404.
25. 马玉英, 杜广胜, 杨晚青, 等. 盐酸纳洛酮在脑复苏中的疗效观察. 农垦医学, 2000; 22(2): 91.
26. 曹秋菊, 孙瑞林. 纳洛酮用于心脑肺复苏术31例临床分析. 镇江医学院学报, 1999; 9(2): 229.
27. Zhuang XL, Zeng YM, Chen BL. Editor-in-chief. Modern Anesthesiology. 3rd ed. Beijing: People’s Medical Publishing House; 2004. 2306–2311.
28. Chen KT, Li MT. Endogenous opioid and naloxone. In: Meng QL. Editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 209.
29. Le WM, Han ST. Effect of naloxone on craniocerebral injury and apnoea. Journal of Emergency Medicine, 1997; 6(): 339.
30. Shao X. Cardiopulmonary-cerebral Resuscitation. In: Shao X. Jiang ZM. editor-in-chief. Shanghai: Shanghai Science and Technique Press; 1992. 55–69.
31. Lou HC, Tweed WA, Davis JM. Preferential blood flow increase tothe brain stem in moderate neonatal hypoxia: reyersal by naloxone. EurJ Pediatr, 1985; 144(): 225.
32. Meng QL, Hu CX, Hou YK. Mechanism of antagonism of naloxone to ethanol. Chinese Journal of Critical Care Medicine, 1996; 16(): 2.
33. Yang TD, Liu QY, Cheng YS, et al. Effect of naloxone for ultrastructure of ischemia reperfusion cardiac muscle. In: Meng QL. editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 6–8.
34. Hughes GS. Naloxone and methylprednisolone sodium succinate enhance sympathomedullary discharge in patients with septic shock. Life sci, 1984; 35(): 2319.
35. Mcintosh TK. Effect of an opiate antagonist (naloxone) and agonist/ an2tagonist (nalbuphine) in primate hemorrhagic shock : relationship to cat2echolaminer elease. Cire shock, 1985; 17(): 313.
36. McGuire W, Fowlie PW. Naloxone for narcotic exposed newborn infants: systematic review. Archives of Disease in Childhood Fetal & Neonatal Edition, 2003; 88(4): F308–F311.
37. Cheng TD, Dong CM, Li PJ, et al. Clinical study on the administration of naloxone during closed-chest cardiopulmonary-cerebral resuscitation. Journal of Emergency Medicine, 2000; (1): 5–7.
38. Li T, Wu Y. Efficacy evaluation of naloxone in 24 cases of cardiopulmonary-cerebral resuscitation. Journal of Jilin University (Medicine Edition), 2004; 30(5): 768.
39. Yao PA, Song XQ. Clinical efficacy on the administration of naloxone during cardiopulmonary-cerebral resuscitation. Chinese Research Journal of Practical Medicine, 2004; 3(6): 507–508.
40. Che HM. Application of naloxone during cardiopulmonary resuscitation after acute toxicosis. Chinese Clinical Medicine, 2004; 5(2): 94.
41. Luo BQ, Huang CJ, Wu ZB, et al. Naloxone combined with adrenaline for cardiopulmonary resuscitation. Clinical Focus, 2003; 18(9): 523–524.
42. Guo MH, Ren JY, Zhao L. Effect of Naloxone combined with adrenaline for cardiopulmonary resuscitation. Journal of Practical Medical Techniques, 2005; 12(2B): 459.
43. Liu XJ, Yu SL. Efficacy evaluation of naloxone for cardiopulmonary-cerebral resuscitation. Guizhou Medical Journal, 2002; 26(1): 40–41.
44. Lin X, Zheng W, Zhu HG. Application of naloxone in cardiopulmonary-cerebral resuscitation. Chinese Medicine of Factory and Mine, 2006; 19(1): 18–19.
45. Zhao LM, Zhang ZS, Liu YQ. Clinical observation of naloxone for cardiac arrest. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2006; 15(5): 584–585.
46. Wang XF, Wang RB. Clinical efficacy of naloxone for cerebral resuscitation. Medical Forums in Basic, 2004; 8(1): 43.
47. Guo MH, Ren JY, Zhao L. Clinical efficacy of naloxone combined with adrenaline for 33 cardiopulmonary-cerebral resuscitation cases. Chinese Journal of General Practitioners, 2005; 4(9): 553.
48. Chen TZ, Dong CM, Li PJ, et al. Clinical efficacy of the administration of naloxone during cardiopulmonary-cerebral resuscitation. Gansu Science and Technology, 1999; (4).
49. Dong CM, Chen TZ, Li PJ. Clinical application of naloxone in cardiopulmonary resuscitation. Chinese Journal of Medicine, 2000; 35(11): 49.
50. Dong CM, Li X, Zhang JM. Clinical study on administration of naloxone during closed-chest cardiopulmonary-cerebral resuscitation. Medical Journal of Trauma and Disability, 2000; 8(3): 38–40.
51. Chen TZ, Dong CM, Li PJ. Efficacy evaluation of naloxone in 21 cases of cardiopulmonary-cerebral resuscitation. Chinese Critical Care Medicine, 2001; 13(3): 182.
52. Gao C, Liu JZ. Study of applying of epinephrine with naloxone hydrochloride to patients during cardiopulmonary resuscitation. Ningxia Medical Journal, 2004; 26(11): 680–682.
53. Wang WQ, Shen JM, Chen SY. Efficacy evaluation of large dose naloxone for cardiopulmonary-cerebral resuscitation. Clinical Medicine of China, 2003; 19(11): 989–990.
54. Cui XF. Naloxone combined with routine cardiopulmonary resuscitation for cardiac arrest. Journal of Youjiang Medical College For Nationalities, 2000; (3): 403–404.
55. Ma YY, Du GS, Yang WQ, et al. Efficacy evaluation of naloxone for cerebral resuscitation. Agricultural Reclamation Medicine, 2000; 22(2): 91.
56. Cao QJ, Sun RL. Clinical analysis of naloxone in 31 cases of cardiopulmonary-cerebral resuscitation. Journal of Zhenjiang Medical College, 1999; 9(2): 229.

Chinese Journal of Evidence-Based Medicine

Naloxone for Cardio - Pulmonary - Cerebral Resuscitation: A Systematic Review

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