|
妊娠期间能服用地西泮吗？ 妊娠中的入睡困难 妊娠中的睡眠，尤其妊娠后期，基本都是碎片化的，特点是睡眠发生后容易醒转，存在大量的浅层睡眠和 较少的深度睡眠[1-3]。其中的一些原因包括夜尿、夜间胃食管反流、焦虑、不安腿 或 腿痛性痉挛、腰痛、因为体力受限 难以获得舒适体位、以及原先就存在的肥胖、阻塞性睡眠呼吸暂停。 Difficulty sleeping — Sleep during pregnancy,especially late pregnancy, is fragmented and characterized by increased wakingafter sleep onset, greater amounts of light sleep, and less deep sleep [1-3].Some reasons for this include nocturia, nocturnal gastroesophageal reflux,anxiety, restless legs or leg cramps, low back pain, physical limitations inachieving a comfortable position, and, primarily in obese women, obstructivesleep apnea. 妊娠期间获得更好睡眠的建议 在对特定身体状况缺乏特定治疗的条件下（例如胃食管反流），想获得更好睡眠的建议包括：在低刺激环境中保持规律的睡眠时间表；入睡前减少液体摄入；午后避免摄入咖啡因；上床前的几个小时以前至少参加20分钟的体育锻炼；在双膝之间、腹部之下 和 背后放置枕头从而降低腰部的压力；在 洗手间 放置夜灯 从而 避免半夜如厕时需要打开明亮的灯光，后者倾向于增加觉醒状态；使用放松技巧；以及避免后半白天打盹[4]。 In the absence of treatment for a specific medical condition, suchas gastroesophageal reflux disease, suggestions for better sleep includemaintaining a regular sleep schedule in a low stimuli environment; cutting downon the amount of liquids in the hours before bedtime; avoiding caffeine afternoon; exercising regularly for at least 20 minutes at least a few hours beforebedtime; placing pillows between the knees, under the abdomen, and behind theback to take pressure off the lower back; putting a night light in the bathroomto avoid turning on a bright light, which tends to increase wakefulness; usingrelaxation techniques; and avoiding naps late in the day [4]. 妊娠期间助眠药物的使用推荐 我们并不推荐对孕妇使用睡眠药物。 We do not prescribe sleep medication for pregnant women. 虽然有镇静作用的抗组胺药（例如多西拉敏、苯海拉明）或 思诺思 已经被用于 妊娠失眠 的短期治疗。Sedating antihistamines (eg,doxylamine, diphenhydramine) or zolpidem have been used for short-termtreatment of sleeplessness in pregnancy. 妊娠期间使用助眠药物的证据 来自2015年的系统综述 和 16个研究的荟萃分析 评估了苯二氮卓类、催眠性的苯二氮卓类受体激动剂、抗抑郁药物和抗组胺药物在具有睡眠紊乱的孕妇中的作用[5]。 A 2015 systematic review and meta-analysis of 16 studies evaluatedthe use of benzodiazepines, hypnotic benzodiazepine receptor agonists,antidepressants, and antihistamines in pregnant women with sleep disturbances [5]. 总体上，这些研究没有发现这些药物和 先天畸形的危险 之间的关联。 Overall, the studies reported no correlation between use of thesemedications and risk of congenital anomalies. 苯二氮卓类和 催眠性的苯二氮卓类受体激动剂使用 可能会增加早产、低出生体重 和 低胎龄儿的发生几率，但是现有的研究结果倾向于是有偏倚的。同样有担心认为，这些药物经过胎盘途径可能会导致新生儿呼吸抑制。 Benzodiazepines and hypnotic benzodiazepine receptor agonist usemay increase the rates of preterm birth, low birth weight, and small forgestational age infants, but available studies were prone to bias. There isalso concern that transplacental passage of these medications may causeneonatal respiratory depression. 尽管这个荟萃分析 受限于研究数量较少、研究设计大部分为队列研究 以及 较少的研究对象，通常支持孕妇避免使用上述药物。 Although the meta-analysis was limited by the small number ofstudies, study design (most were cohort studies), and small numbers of includedsubjects, it generally supports avoiding such medications in pregnancy. 来自不同研究的、相矛盾的结果认为，我们尚不知晓，妊娠期暴露于苯二氮卓类药物 或 催眠性的、苯二氮卓类受体激动剂（例如扎来普隆、唑吡坦、佐匹克隆）是否就一定和 增加的先天畸形有关。Due to conflicting results across studies, it isnot known if exposure to either benzodiazepines or hypnotic benzodiazepinereceptor agonists (eg, zaleplon, zolpidem, or zopiclone) during pregnancy isassociated with an increased risk of congenital malformations. 然而，来自于一个系统综述的、其中包括9个观察性研究的、超过一百万研究对象的、最好的证据发现，苯二氮卓类药物并不和增加的畸形危险相关[6]。However, the best data,from a systematic review that included nine observational studies with morethan one million subjects, suggest that benzodiazepines are not associated withan increased risk [6]. 来自于这个系统性综述和其它观察性研究结果的荟萃分析发现，苯二氮卓类药物和出生缺陷没有关联[7-9]。 Meta-analysesfrom this systematic review and results from other observational studies notincluded in the review all indicate that benzodiazepines are not associatedwith birth defects [49-51]: 来自魏社鹏的总结：遍查文献，原来短期使用这些助眠药物是可行的，大量的证据并没有发现服用这些药物和胎儿畸形之间存在关联。但是怀孕期间，能不用还是尽可能不用这些药物，实在要用，短期使用还是可行的。 注： 苯二氮卓类药物 苯二氮卓类（benzodiazepines）多为1,4-苯并二氮的衍生物。临床常用的有20余种。虽然它们结构相似，但不同衍生物之间，抗焦虑、镇静催眠、抗惊厥、肌肉松弛和安定作用则各有侧重。最常见的此类药物包括：地西泮（diazepam，安定）、氟西泮（flurazepam，氟安定）、氯氮（chlordiazepoxide）、奥沙西泮（oxazepam） 和 三唑仑（triazolam）。 参考文献 1. Wilson DL, BarnesM, Ellett L, et al. Decreased sleep efficiency, increased wake after sleeponset and increased cortical arousals in late pregnancy. Aust N Z J ObstetGynaecol 2011; 51:38. 2. Hertz G, Fast A,Feinsilver SH, et al. Sleep in normal late pregnancy. Sleep 1992; 15:246. 3. Okun ML, Kiewra K,Luther JF, et al. Sleep disturbances in depressed and nondepressed pregnantwomen. Depress Anxiety 2011; 28:676. 4. National Sleep Foundation. Pregnancyand sleep. www.sleepfoundation.org/article/sleep-topics/pregnancy-and-sleep(Accessed on October 06, 2011). 5. Okun ML, Ebert R,Saini B. A review of sleep-promoting medications used in pregnancy. Am J ObstetGynecol 2015; 212:428. 6. National Institute for Health and CareExcellence (NICE). Antenatal and postnatal mental health: clinical managementand service guidance. NICE clinical guideline 192. December 2014.http://www./guidance/cg192 (Accessed on August 27, 2015). 7. Koren G, PastuszakA, Ito S. Drugs in pregnancy. N Engl J Med 1998; 338:1128. 8. Eros E, CzeizelAE, Rockenbauer M, et al. A population-based case-control teratologic study ofnitrazepam, medazepam, tofisopam, alprazolum and clonazepam treatment duringpregnancy. Eur J Obstet Gynecol Reprod Biol 2002; 101:147. 9. Reis M, KällénB. Combined use of selective serotonin reuptake inhibitors andsedatives/hypnotics during pregnancy: risk of relatively severe congenitalmalformations or cardiac defects. A register study. BMJ Open 2013; 3. |
|
|
