【Cochrane简语概要】扑热息痛用于缓解产后会阴疼痛

研究问题是什么？

本Cochrane综述的目的是了解单剂量的扑热息痛（对乙酰氨基酚）是否能降低阴道分娩后女性会阴部疼痛的发生率。我们收集并分析了所有相关研究来回答这个问题（检索日期2019年12月）。

（图片来自medbriefnamibia.com）

为什么这个问题很重要？

对于妇女和家庭来说，婴儿的出生应该是一个非常特殊的时刻。会阴部疼痛有时会影响女性的健康，并导致她们在照顾婴儿时出现问题。

会阴是阴道和肛门之间的菱形区域，在婴儿出生时可能会瘀伤或撕裂。一些女性会为了婴儿出生而切开会阴（会阴切开术）。会阴切开术和自然撕裂需要缝合（缝合术）。也可能需要使用产钳或抽吸器（吸罐）来帮助婴儿出生。任何此类干预都可能导致会阴部不适和疼痛。减少会阴部创伤和经常会阴部剧烈疼痛的机会显然很重要，因为它会降低女性四处走动、母乳喂养和照顾婴儿的能力。它还可能导致尿失禁或大便失禁以及性交疼痛。疼痛可持续数周、数月，有时甚至更久。因此，充分的疼痛控制很重要。

关于扑热息痛的本综述是一系列综述的一部分，这些综述着眼于在分娩后的最初几个小时内帮助缓解会阴疼痛的药物。

我们找到了什么证据？

我们在本次更新中没有发现新的研究，因此本综述仍然包括涉及1301名女性的10项研究。这些研究相当古老，从1970年代到1990年代初期。所有研究都关注与创伤相关的会阴疼痛缓解，没有发现疼痛与完整会阴相关的研究。总体而言，由于报告的方法不明确和结果的差异，证据质量低。

扑热息痛可能会减少产后4小时出现疼痛的女性人数（10项试验，1279名女性），更少的女性可能需要使用扑热息痛额外缓解疼痛（8项试验，1132名女性）。

只有一项研究报告了出现恶心（感觉恶心）或嗜睡的女性人数，但未发现明显差异。此外没有其他副作用，也没有研究关注对婴儿的影响。

这些证据意味着什么？

扑热息痛作为止痛药通常是有效的，并且几乎没有副作用。本综述表明，单剂量的扑热息痛可能对阴道分娩后的会阴疼痛有一些好处。应告知哺乳期妇女有关扑热息痛对母乳喂养婴儿影响的可用信息很少。

作者结论: 

单剂量的扑热息痛可改善阴道分娩后会阴部疼痛的缓解，并可能减少额外缓解疼痛的需要。对妇女和新生儿的潜在不良反应没有进行适当的评估。任何进一步的试验还应解决有关孕产妇结局的证据差距，例如对产后护理的满意度、孕产妇功能/幸福感（情感依恋、自我效能、能力、自主性、信心、自我保健、应对技巧）和新生儿药物不利影响。

作者:Abalos E, Sguassero Y, Gyte GML；译者：裴旭燕，审校：刘琴，重庆医科大学公共卫生与管理学院循证医学中心 Cochrane中国协作网成员单位 The Cochrane China Network Affiliate School of Public Health and Management, Chongqing Medical University；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】Paracetamol for relief of perineal pain after birth

What is the issue?

The aim of this Cochrane Review was to find out if a single dose of paracetamol (acetaminophen) reduces the incidence of perineal pain for women after giving birth vaginally. We collected and analysed all relevant studies to answer this question (search date December 2019).

Why is this important?

The birth of a baby should be a very special time for women and families. Perineal pain can sometimes interfere with women's well-being and cause them problems in looking after their babies.

The perineum is a diamond-shaped area between the vagina and the anus that can bruise or tear as the baby is born. Some women are given a cut to the perineum (an episiotomy) for the baby to be born. Episiotomies and natural tears require stitches (sutures). Forceps or suction (ventouse) may also need to be used to help the baby to be born. Any such intervention can cause perineal discomfort and pain. Reducing the chance of perineal trauma and often intense perineal pain is clearly important as it can reduce a woman's ability to move around, breastfeed, and care for her baby. It can also cause urinary or fecal incontinence and painful sex. The pain can persist for weeks, months, or sometimes more. Adequate pain control is therefore important.

This review on paracetamol is part of a series of reviews looking at medicines to help relieve perineal pain in the first few hours after giving birth.

What evidence did we find?

We found no new studies in this update, so the review still includes 10 studies involving 1301 women. The studies were quite old, ranging from the 1970s to the early 1990s. All the studies looked at perineal pain relief associated with trauma, and no studies where the pain was associated with intact perineum were found. Overall, the evidence was of low quality due to the unclear methodology reported and the variation of findings.

Paracetamol may reduce the number of women experiencing pain at four hours after birth (10 trials, 1279 women), and fewer women may need additional pain relief with paracetamol (eight trials, 1132 women).

Only one study reported the number of women experiencing nausea (feeling sick) or sleepiness with no clear differences identified. There were no other side effects and none of the studies looked at effects on the babies.

What does this mean?

Paracetamol is generally effective as painkiller and causes few side effects. This review showed there may be some benefit specifically with a single dose of paracetamol for perineal pain after vaginal birth. Lactating women should be advised about the little information available on the effects of paracetamol in breastfed babies

Authors' conclusions: 

A single dose of paracetamol may improve perineal pain relief following vaginal birth, and may reduce the need for additional pain relief. Potential adverse effects for both women and neonates were not appropriately assessed. Any further trials should also address the gaps in evidence concerning maternal outcomes such as satisfaction with postnatal care, maternal functioning/well-being (emotional attachment, self-efficacy, competence, autonomy, confidence, self-care, coping skills) and neonatal drug adverse effects.

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