【原】【罂粟摘要】阿片类药物用于产科硬脊膜穿破后头痛的预防：一项有效性和安全性的系统回顾和Meta分析

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阿片类药物用于产科硬脊膜穿破后头痛的预防：一项有效性和安全性的系统回顾和Meta分析

贵州医科大学  麻醉与心脏电生理课题组

翻译：吴学艳  编辑：张中伟  审校：曹莹

背景

       硬脊膜穿破后头痛(PDPH)或脊髓性头痛，是产妇在硬膜外麻醉或脊髓麻醉期间医源性穿破硬脊膜和脑脊液(CSF)外漏最常见的严重并发症。

目的

       分析阿片类药物在产妇接受椎管内麻醉时意外穿破硬脊膜后预防性治疗头痛中的有效性和安全性。

研究设计

      系统回顾和荟萃分析。

环境

      研究类型不限。

方法

       检索PubMed、Embase及Cochrane图书馆截止2020年9月前所发表的论文。

结果

    根据入选标准，共纳入10项研究，主要观察指标为硬脊膜穿破后头痛(PDPH)，次要观察指标为硬膜外血补丁次数(EBP)次数。每项研究的风险估计以比值比(ORs)形式报告。结果显示；吗啡不能降低PDPH发生率(OR=0.45, 95% CI:0.15～1.34,P=0.153，I²=74.4%，异质性= 0.004)，也不能减少EBP治疗需要量(OR=0.40, 95%CI:0.08～1.95,P=0.259,I²=73.7%，异质性=0.004)；芬太尼不能降低PDPH的发生率(OR=0.35，95%CI：0.01～13.77，P=0.576，I²=81.0%，异质性=0.022)。

局限性

    纳入研究数量较少，异质性高，研究设计多样化。

结论

    阿片类药物不能降低医源性硬脊膜穿破后头痛风险，也不能减少PPHD的EBP治疗需要量。

原始文献来源

      Wu L, Chen S, Jiang X, et al. Opioids for the Prevention of Post-dural Puncture Headache in Obstetrics: A Systematic Review and Meta-analysis of Efficacy and Safety[J]. Pain Physician. 2021 Nov;24(7):E1155-E1162.

Opioids for the Prevention of Post-dural Puncture Headache in Obstetrics: A Systematic Review and Meta-analysis of Efficacy and Safety

Abstract

Background: Post-dural puncture headache (PDPH), or spinal headache, is the most common serious complication resulting from iatrogenic puncture of the dura during epidural or spinal anesthesia and cerebrospinal fluid (CSF) leak in pregnant women.

Objective: To analyze the effectiveness and safety of opioids as a prophylaxis approach in treating obstetric patients who underwent unintentional dural puncture during the initiation of neuraxial anesthesia.

Study design: A systematice review and meta-analysis.

Setting: No restriction regarding study type.

Methods: PubMed, Embase, and the Cochrane library were searched for available papers published up to September 2020.

Results: According to the eligibility criteria, 10 studies were included with post-dural puncture headache (PDPH) incidence as the primary outcome and the number of epidural blood patch (EBP) required as the second outcome. The risk estimates of each study were reported as odds ratios (ORs). The results showed morphine does not decrease the incidence of PDPH (OR = 0.45, 95% CI: 0.15 - 1.34, P = 0.153, I2 = 74.4%, Pheterogeneity = 0.004) and the use of EBP (OR=0.40, 95%CI:0.08-1.95, P=0.259, I2=73.7%, Pheterogeneity =0.004). Fentanyl does not decrease the incidence of PDPH (OR= 0.35, 95% CI: 0.01-13.77, P = 0.576, I2 = 81.0%, Pheterogeneity= 0.022).

Limitations: The small number of included studies, high heterogeneity, and variety in study designs.

Conclusions: Exposure to opioids for any reason after the diagnosis of unintentional dural puncture is not associated with a reduced risk of PDPH and does not decrease the need for therapeutic EBP.

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