Anaesthetic Department, St Thomas' Hospital, London, UK.
Best Pract Res Clin Obstet Gynaecol. 2010 Jun;24(3):289-302. doi: 10.1016/j.bpobgyn.2009.11.003. Epub 2009 Dec 11.
Maternal labour pain and stress are associated with progressive fetal metabolic acidosis. Systemic opioid analgesia does little to mitigate this stress, but opioids readily cross the placenta and cause fetal-neonatal depression and impair breast feeding. Pethidine remains the most widely used, but alternatives, with the possible exception of remifentanil, have little more to offer. Inhalational analgesia using Entonox is more effective and, being rapidly exhaled by the newborn, is less likely to produce lasting depression. Neuraxial analgesia has maternal physiological and biochemical effects, some of which are potentially detrimental and some favourable to the fetus. Actual neonatal outcome, however, suggests that benefits outweigh detrimental influences. Meta-analysis demonstrates that Apgar score is better after epidural than systemic opioid analgesia, while neonatal acid-base balance is improved by epidural compared to systemic analgesia and even compared to no analgesia. Successful breast feeding is dependent on many factors, therefore randomized trials are required to elucidate the effect of labour analgesia.
产妇分娩疼痛和应激与胎儿进行性代谢性酸中毒有关。全身阿片类药物镇痛对缓解这种应激作用甚微，但阿片类药物很容易穿过胎盘，导致胎儿-新生儿抑郁，并影响母乳喂养。哌替啶仍然是最广泛使用的药物，但除了瑞芬太尼之外，其他替代药物的作用也不大。使用恩丹西酮吸入性镇痛更为有效，且由于新生儿迅速呼出，不太可能产生持久的抑郁。脊神经镇痛对产妇有生理和生化影响，其中一些可能有害，而一些则有利于胎儿。然而，实际的新生儿结局表明，益处大于不利影响。荟萃分析表明，硬膜外镇痛后的阿普加评分优于全身阿片类药物镇痛，而与全身镇痛甚至无镇痛相比，硬膜外镇痛可改善新生儿酸碱平衡。成功的母乳喂养取决于许多因素，因此需要进行随机试验来阐明分娩镇痛的效果。
