芬太尼分娩镇痛对母乳喂养影响的系统评价  

Influence of fentanyl for labor analgesia on breastfeeding:a systematic evaluation

作　　者：朱笑笑 夏海鸥[1] 余燕飞 盛佳[2] Zhu Xiaoxiao;Xia Hai′ou;Yu Yanfei(School of Nursing,Fudan University,Shanghai 200032 China)

机构地区：[1]复旦大学护理学院 [2]复旦大学附属妇产科医院

出　　处：《护理研究》2018年第20期3213-3221,共9页Chinese Nursing Research

基　　金：复旦大学复星护理科研基金;编号:FNF201720

摘　　要：[目的]评价芬太尼分娩镇痛对产后母乳喂养影响。[方法]计算机检索Cochrane Database of Systematic Reviews、JBI Data base of Systematic Reviews、Embase、PubMed、EBSCO、Web of Science、万方数据、中国知网、维普资讯中英文数据库中关于分娩中使用芬太尼镇痛对产后母乳喂养影响的随机对照试验(RCT)和类实验性研究(QES),检索时限为建库至2016年11月1日,同时筛检纳入文献的参考文献。由3名研究者对文献质量进行严格评价和资料提取,运用RevMan 5.3软件对符合标准的RCT和QES进行Meta分析或进行描述性分析。[结果]共纳入8篇文献,其中有6篇RCT、2篇QES,共计2 476例病人。结果显示芬太尼用于分娩镇痛对初始母乳喂养率和6周纯母乳喂养率均没有影响,但高剂量的芬太尼组产后6周停止母乳喂养率增加;对母乳喂养持续时间没有影响;对12个月内的泌乳量没有影响;增加6周母乳喂养困难率,主要表现为婴儿不能含接住乳头等;缩短产后1h内的泌乳始动时间;促进产后24h和48h血清泌乳素的分泌。[结论]芬太尼用于分娩镇痛,在缩短产后1h内的泌乳始动时间,促进产后24h和48h的泌乳素分泌的同时,并没有影响产后早期纯母乳喂养率、6周纯母乳喂养率、母乳喂养持续时间以及母乳量,但是高剂量的芬太尼组可能增加产后6周母乳喂养困难率。故芬太尼用于分娩镇痛对产后母乳喂养而言是安全的,建议临床工作者使用时控制其剂量。Objective:To evaluate the influence of fentanyl for labor analgesia on postpartum breastfeeding.Methods:Randomized controlled trials(RCT)and quasi experimental studies(QES)on the influence of fentanyl for labor analgesia on postpartum breastfeeding were retrieved from Chinese and English databases including Cochrane Database of Systematic Reviews,JBI Database of Systematic Reviews,Embase,PubMed,EBSCO,Web of Science,Wanfang Data,China Knowledge Network and VIP Database from the establishment of the library until November 1,2016,while screening the references included in the literatures.The quality of the literature was rigorously evaluated and extracted by three investigators.Meta analysis or descriptive analysis was performed on the RCT and QES that met the criteria using the RevMan5.3 software.Results:A total of 8 articles including 6 RCTs and 2 QES involved with 2476 patients.The results showed that fentanyl for labor analgesia had no effect on the initial breastfeeding rate and the 6 week exclusive breastfeeding rate,while in high dose fentanyl group the rate of stopped breastfeeding for 6 weeks after delivery increased.There was no effect on the duration of breastfeeding and lactation in 12 months.It increased the difficulty rate of breastfeeding for 6 weeks,main manifestations were that the baby could not contain the breast.It could shorten postpartum lactation start time within 1 h.It could promote postpartum 24 h and 48 h Secretion of serum prolactin.Conclusions:Fentanyl used for labor analgesia could shorten the lactation start time within 1 hour after birth and promote prolactin secretion at 24 h and 48 h postpartum,in the meantime,it did not affect the early postpartum exclusive breastfeeding rate,exclusive breastfeeding for 6 weeks,duration of breastfeeding,and breast milk volume.While high dose fentanyl might increase the difficulty rate of postpartum breastfeeding for 6 weeks.Therefore,fentanyl for labor analgesia was safe for postpartum breastfeeding,but the dose should be controlled in clinic.

关 键 词：芬太尼 分娩 镇痛 母乳喂养 泌乳始动时间 早期纯母乳喂养率 

分 类 号：R47[医药卫生—护理学]