剖宫产术后椎管内阿片类药物吗啡的使用与呼吸抑制发生率的关系：系统性评价

A Systematic Review Evaluating Neuraxial Morphine and Diamorphine-Associated Respiratory Depression After Cesarean Delivery

背景与目的

剖宫产术后椎管内阿片类药物引起呼吸抑制（CSRD）的发生率尚不清楚。本研究旨在回顾相关病例报告的呼吸抑制（ARD）患病率，从而计算CSRD发生率。

方 法

该试验对6个数据库进行了文献检索，以明确在进行椎管内麻醉剖宫产分娩的产妇中，继发吗啡或二吗啡的ARD。主要指标为：CSRD的“最高”（确定的和可能的/可能的）和“最低”（确定的）患病率。次要指标为：（1）目前临床剂量的椎管内阿片类药物相关的CSRD患病率，（2）每项研究自身标准所定义的ARD患病率，（3）ARD病例报告，（4）1990年至2016年麻醉索赔项目数据库中ARD患病率。

结 果

本研究纳入78篇文章，共18,455名剖宫产产妇于椎管内接受了吗啡或二甲吗啡。所有剂量的椎管内阿片类药物的CSRD的最高和最低患病率分别为8.67 / 10,000（95％CI，4.20-15.16）和5.96 / 10,000（95％CI，2.23-11.28）。使用临床剂量的神吗啡的CSRD的最高和最低患病率分别在1.63 / 10,000（95％CI，0.62-8.77）和1.08 / 10,000（95％CI，0.24-7.22）之间。每篇论文定义的ARD患病率为每10,000人61例（95％CI，51-74）。

结 论

椎管内麻醉使用吗啡或二吗啡引起的CSRD发生率较低。

原始文献摘要

Sharawi N， Carvalho B ， Habib AS ，etal；A Systematic Review Evaluating Neuraxial Morphine and Diamorphine-Associated Respiratory Depression After Cesarean Delivery；Anesth Analg 2018 Jul 11

Background:The prevalence of neuraxial opioid-induced clinically significant respiratory depression (CSRD) after cesarean delivery is unknown. We sought to review reported cases of author-reported respiratory depression (ARD) to calculate CSRD prevalence.

Methods:A 6-database literature search was performed to identify ARD secondary to neuraxial morphine or diamorphine, in parturients undergoing cesarean delivery. "Highest" (definite and probable/possible) and "lowest" (definite) prevalences of CSRD were calculated. Secondary outcomes included: (1) prevalence of CSRD associated with contemporary doses of neuraxial opioid, (2) prevalence of ARD as defined by each study's own criteria, (3) case reports of ARD, and (4) reports of ARD reported by the Anesthesia Closed Claims Project database between 1990 and 2016.

Results:We identified 78 articles with 18,455 parturients receiving neuraxial morphine or diamorphine for cesarean delivery. The highest and lowest prevalences of CSRD with all doses of neuraxial opioids were 8.67 per 10,000 (95% CI, 4.20-15.16) and 5.96 per 10,000 (95% CI, 2.23-11.28), respectively. The highest and lowest prevalences of CSRD with the use of clinically relevant doses of neuraxial morphine ranged between 1.63 per 10,000 (95% CI, 0.62-8.77) and 1.08 per 10,000 (95% CI, 0.24-7.22), respectively. The prevalence of ARD as defined by each individual paper was 61 per 10,000 (95% CI, 51-74). One published case report of ARD met our inclusion criteria, and there were no cases of ARD from the Closed Claims database analysis.

Conclusions:These results indicate that the prevalence of CSRD due to neuraxial morphine or diamorphine in the obstetric population is low.

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