St Thomas' Hospital, London, UK.
Int J Obstet Anesth. 2011 Jan;20(1):38-50. doi: 10.1016/j.ijoa.2010.08.004. Epub 2010 Dec 13.
When investigating different methods of maternal pain relief in labour, neonatal outcome has not always been at the forefront, or else maternal changes, such as haemodynamics, fever, length of labour, need for oxytocin or type of delivery, are taken as surrogates for neonatal outcome. It is essential to examine the actual baby and to appreciate that labour pain itself has adverse consequences for the baby. For systemic analgesia, pethidine has been most extensively studied and compared with neuraxial analgesia. It depresses fetal muscular activity, aortic blood flow, short-term heart rate variability and oxygen saturation. In the newborn it exacerbates acidosis, depresses Apgar scores, respiration, neurobehavioural score, muscle tone and suckling. Alternatives have few advantages, remifentanil being the most promising. Neuraxial analgesia is associated with better Apgar scores and variable neurobehavioural changes. Neonatal acid-base status is not only better with epidural than with systemic opioid analgesia, it is also better than with no analgesia. The effect on breast feeding has yet to be established, though it is certainly no worse than that of systemic opioid analgesia. Variations in neuraxial technique have little impact on the newborn. Widespread ignorance of the benefit to the newborn of neuraxial labour analgesia in the UK among non-anaesthetists needs to be combated.
在研究分娩时的不同产妇止痛方法时，新生儿结局并不总是处于首要地位，否则，产妇的变化，如血液动力学、发热、产程、催产素需求或分娩方式，将被视为新生儿结局的替代指标。检查新生儿的实际情况非常重要，要意识到分娩疼痛本身对婴儿有不良影响。对于全身镇痛，哌替啶的研究最为广泛，并与椎管内镇痛进行了比较。它会抑制胎儿的肌肉活动、主动脉血流、短期心率变异性和氧饱和度。在新生儿中，它会加重酸中毒、降低 Apgar 评分、呼吸、神经行为评分、肌肉张力和吸吮能力。其他替代方法的优势较少，瑞芬太尼是最有前途的一种。椎管内镇痛与更好的 Apgar 评分和可变的神经行为变化有关。新生儿酸碱状态不仅硬膜外镇痛比全身阿片类镇痛更好，而且比无镇痛更好。其对母乳喂养的影响尚未确定，但肯定不会比全身阿片类镇痛更差。神经轴技术的变化对新生儿影响不大。在英国，非麻醉师对椎管内分娩镇痛对新生儿有益的认识不足，需要加以纠正。
