Influence of Remifentanil on Newborns During Cesarean Section under General Anesthesia: A Meta Analysis_West China Medical Journal

Authors：

GU Juan ¹ , CHEN Jie ² , CHEN Yuanjing ¹ ,  LIU Bin ¹

1. Department of Anesthesiology; 2. Center of Evidence-based Medicine; West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Bin, Email: gujuangujuan@163.com

Keywords：

瑞芬太尼; 新生儿; 剖宫产; Meta分析

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目的　系统评价瑞芬太尼用于全身麻醉下剖宫产时对新生儿的影响。方法　检索Cochrane Library、PubMed、OVID、EMbase、CNKI、万方等中外数据库，收集1990年－2012年关于瑞芬太尼用于全身麻醉下剖宫产的临床随机对照研究。按Cochrane系统评价方法评估文献质量，用Revman 5.1软件对提取的数据进行Meta分析。结果　共纳入10项研究，包括342例产妇。与空白对照组相比，瑞芬太尼降低新生儿1 min Apgar评分[WMD=?0.46，95%CI（?0.65，?0.27），P＜0.000 01]，提高出生时脐动脉pH值[WMD=0.01，95%CI（0.00，0.02），P=0.004]，增加出生时窒息发生率[RR=1.76，95%CI（1.06，2.95），P=0.03]；当诱导剂量为1.0～1.5 μg/kg时，对5 min Apgar评分无影响[WMD=?0.14，95%CI（?0.32，0.04），P=0.13]。结论　瑞芬太尼用于全身麻醉剖宫产可减轻新生儿酸中毒，但是会对新生儿产生一过性的呼吸抑制。

Citation： GU Juan,CHEN Jie,CHEN Yuanjing,LIU Bin. Influence of Remifentanil on Newborns During Cesarean Section under General Anesthesia: A Meta Analysis. West China Medical Journal, 2012, 27(9): 1361-1365. doi: Copy

1.	Rittmaster RS, Cutler Jr GB, Sobel DO, et al. Morphine inhibits the pituitary-adrenal response to ovine corticotropinreleasing hormone in normal subjects[J]. J Clin Endocrinol Metab, 1985, 60(5): 891-895.
2.	Kan RE, Hughes SC, Rosen MA, et al. Intravenous remifentanil: placental transfer, maternal and neonatal effects[J]. Anesthesiology, 1998, 88(6): 1467-1474.
3.	Draisci G, Valente A, Suppa E, et al. Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial[J]. Int J Obstet Anesth, 2008, 17(2): 130-136.
4.	Ngan Kee WD, Khaw KS, Ma KC, et al. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial[J]. Anesthesiology, 2006, 104(1): 14-20.
5.	Yoo KY, Jeong CW, Park BY, et al. Effects of remifentanil on cardiovascular and bispectral index responses to endotracheal intubation in severe pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia[J]. Br J Anaesth, 2009, 102(6): 812-819.
6.	赵娜, 李有长. 瑞芬太尼在剖宫产麻醉中应用的研究[J]. 重庆医学, 2006, 35(21): 1976-1977.
7.	陈皆锋, 张新民, 丁洁岚, 等. 瑞芬太尼复合异丙酚用于剖宫产术产妇全麻的临床效果观察[J]. 安徽医药, 2006, 10(2): 102-103.
8.	刘琳, 严海雅. 瑞芬太尼用于剖宫产术全身麻醉对母婴的影响[J]. 现代实用医学, 2010, 22(6): 668-669.
9.	Park BY, Yoo KY, Lee MK, et al. Maternal and neonatal effects of remifentanil used during induction of general anesthesia in preeclamptic patients undergoing cesarean delivery[J]. Korean J Anesthesiol, 2009, 57(1): 62-68.
10.	曾葵, 杨莹莹, 黄瀚, 等. 剖宫产全麻诱导使用瑞芬太尼对新生儿的影响[J]. 四川大学学报(医学版), 2009, 40(4): 755-757.
11.	Bouattour L, Ben Amar H, Bouali Y, et al. Maternal and neonatal effects of remifentanil for general anaesthesia for Caesarean delivery[J]. Ann Fr Anesth Reanim, 2007, 26(4): 299-304.

1. 　Rittmaster RS, Cutler Jr GB, Sobel DO, et al. Morphine inhibits the pituitary-adrenal response to ovine corticotropinreleasing hormone in normal subjects[J]. J Clin Endocrinol Metab, 1985, 60(5): 891-895.
2. 　Kan RE, Hughes SC, Rosen MA, et al. Intravenous remifentanil: placental transfer, maternal and neonatal effects[J]. Anesthesiology, 1998, 88(6): 1467-1474.
3. 　Draisci G, Valente A, Suppa E, et al. Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial[J]. Int J Obstet Anesth, 2008, 17(2): 130-136.
4. 　Ngan Kee WD, Khaw KS, Ma KC, et al. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial[J]. Anesthesiology, 2006, 104(1): 14-20.
5. 　Yoo KY, Jeong CW, Park BY, et al. Effects of remifentanil on cardiovascular and bispectral index responses to endotracheal intubation in severe pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia[J]. Br J Anaesth, 2009, 102(6): 812-819.
6. 　赵娜, 李有长. 瑞芬太尼在剖宫产麻醉中应用的研究[J]. 重庆医学, 2006, 35(21): 1976-1977.
7. 　陈皆锋, 张新民, 丁洁岚, 等. 瑞芬太尼复合异丙酚用于剖宫产术产妇全麻的临床效果观察[J]. 安徽医药, 2006, 10(2): 102-103.
8. 　刘琳, 严海雅. 瑞芬太尼用于剖宫产术全身麻醉对母婴的影响[J]. 现代实用医学, 2010, 22(6): 668-669.
9. 　Park BY, Yoo KY, Lee MK, et al. Maternal and neonatal effects of remifentanil used during induction of general anesthesia in preeclamptic patients undergoing cesarean delivery[J]. Korean J Anesthesiol, 2009, 57(1): 62-68.
10. 　曾葵, 杨莹莹, 黄瀚, 等. 剖宫产全麻诱导使用瑞芬太尼对新生儿的影响[J]. 四川大学学报(医学版), 2009, 40(4): 755-757.
11. 　Bouattour L, Ben Amar H, Bouali Y, et al. Maternal and neonatal effects of remifentanil for general anaesthesia for Caesarean delivery[J]. Ann Fr Anesth Reanim, 2007, 26(4): 299-304.

West China Medical Journal

Influence of Remifentanil on Newborns During Cesarean Section under General Anesthesia: A Meta Analysis

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