系统综述问题
全身性阿片类药物在减轻新生儿手术后疼痛方面的有效性和安全性如何？
（图片来自mieye.com）
研究背景
新生儿（出生后前4周内的婴儿）可能会接受手术或外科手术。与成人一样，婴儿也会经历疼痛，并且必须在手术后控制（减轻）这种疼痛。阿片类药物是止痛药，例如可待因和吗啡。阿片类药物通过与体内的阿片受体相互作用并减轻疼痛感来发挥作用。
阿片类药物会影响整个身体系统，因此本综述将它们称为全身性阿片类药物。阿片类药物可以通过不同途径以几种方式给予婴儿。一种方法是使用针头注入静脉；这称为胃肠外给药。另一种方法（或途径）是将药物放入婴儿口中、舌下或用管道。这些类型的药物输送称为肠内给药。与大多数药物一样，阿片类药物可以不同强度（剂量）给药。阿片类药物可以连续给药（不间断），或在一段时间内断断续续（间歇性）。
总结来说，如何给婴儿使用阿片类药物，使用阿片类药物的频率，以及阿片类药物的强度，这就是药物治疗方案。
本综述旨在评估不同的阿片类药物治疗方案对婴儿的影响。
主要研究结果
本综述纳入了七项研究，涉及504名婴儿。我们发现没有研究比较相同阿片类药物的不同剂量。我们没有发现研究比较相同阿片类药物的不同途径。六项研究比较了连续阿片类药物给药与间歇性阿片类药物给药。一项研究评估了连续输注吗啡与父母或护士控制给药的使用情况。
根据这些研究，我们发现我们无法确定持续或间歇性阿片类药物治疗方案是否更适合控制婴儿的疼痛。由于我们没有找到比较不同剂量阿片类药物的研究，因此我们不知道哪种剂量更能减轻婴儿的疼痛。由于我们没有找到比较不同阿片类药物给药途径的研究，因此我们不知道肠外给药是否比肠内给药更能减轻婴儿的疼痛。纳入的文献表明，与间歇性全身性阿片类药物给药相比，连续全身性阿片类药物输注的有效性仍未确定。我们不确定连续全身性阿片类药物给药和间歇性阿片类药物给药在减轻疼痛方面的有效性。
我们检索了截至2022年6月10日可获得的研究。
作者结论:
与全身性阿片类药物的间歇推注相比，持续输注的证据有限。我们不确定连续输注阿片类药物是否比间歇性阿片类药物推注更能减轻疼痛；没有一项研究报告了本综述的其他主要结局，即初次住院期间的全因死亡率、严重的神经发育障碍，或五岁以上儿童的认知和教育结局。只有一项小型研究报告了使用父母或护士控制镇痛的吗啡输注。
作者：Kinoshita M, Borges do Nascimento IJ, Styrmisdóttir L, Bruschettini M；译者：邵雨娜，Cochrane Hong Kong，香港中文大学医学院那打素护理学院；审校：牟焕玉，Cochrane Hong Kong，香港中文大学医学院那打素护理学院；编辑排版：索于思，北京中医药大学循证医学中心
相关文章链接
【Cochrane Plain Language Summary】How effective and safe are systemic opioids for postoperative pain control and management in neonates?
Review Question
How effective and safe are systemic opioids for reducing newborn babies' pain after surgery?
Background
Neonates (babies in the first four weeks after birth) may undergo surgery (operations) or surgical procedures. Like adults, babies experience pain, and this pain must be managed (reduced) after surgery. Opioids are pain-relieving medications. Examples of opioids are codeine and morphine. Opioids work by interacting with opioid receptors in the body and reducing feelings of pain.
Opioids affect the whole body system and this is why this review refers to them as systemic opioids. Opioids can be given to babies in a few ways, by different routes. One route is by using a needle injected into a vein; this is called parenteral drug administration. Another way (or route) is to place a medication in the baby's mouth, under the tongue or with a tube. These types of drug delivery are called enteral administration. Opioids, like most drugs, can be given at different strengths (dosages). Opioids can be given continuously (without stopping), or on and off over a period of time (intermittently).
All of these things together, how the opioid is given to the baby, how often the opioid is given, and the strength of the opioid, create what is called a drug regimen.
This review aims to evaluate how different opioid regimens affect babies.
Key results
This review included seven studies involving 504 babies. We identified no studies comparing different doses of the same opioid. We identified no studies comparing different routes to delivery of opioids. Six studies compared continuous opioid administration versus intermittent opioid administration. One study assessed the use of continuous morphine infusion compared with a parent- or nurse-controlled administration.
Based on the studies we found that we were unable to determine whether continuous or intermittent opioid regimens are better for controlling babies' pain. Since we did not find studies comparing different dosages of opioids, we do not know which dosage is better for reducing babies' pain. Since we did not find studies comparing different routes of opioid administration, we do not know if parenteral is better than enteral for reducing babies' pain. Considering the body of literature evaluated, the effectiveness of continuous systemic opioid infusion compared with intermittent systemic opioid administration is still undetermined. We are uncertain about the effectiveness of continuous systemic opioid administration and intermittent opioid administration in reducing the pain.
We searched for studies that were available up to 10 June 2022.
Authors' conclusions:
Limited evidence is available on continuous infusion compared to intermittent boluses of systemic opioids. We are uncertain whether continuous opioid infusion reduces pain compared with intermittent opioid boluses; none of the studies reported the other primary outcomes of this review, i.e. all-cause mortality during initial hospitalization, significant neurodevelopmental disability, or cognitive and educational outcomes among children older than five years old. Only one small study reported on morphine infusion with parent- or nurse-controlled analgesia.
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