Abstract：
The purpose of this study was to examine the efficacy of remifentanil on external cephalic version (ECV) in breech presentation. An extensive search was conducted using PubMed, Cochrane Library, and other grey literature. Only randomized controlled trials using remifentanil for ECV were included. Risk ratio (RR) and mean difference (MD) were used to estimate outcomes and quality of evidence was assessed using the Risk of Bias and GRADE system. Five studies consisting of 602 patients were analyzed. Remifentanil resulted in a moderate increase in ECV success rate (RR, 1.19; 95% CI, 1.00 to 1.43; P = .05), a large reduction of pain score (MD, -2.02; 95% CI, -2.32 to -1.72; P < .00001) with fewer transient fetal bradycardia (RR, 0.40; 95% CI, 0.19 to 0.85; P = .02). However, remifentanil did not affect cesarean section rates, (RR, 0.97; 95% CI, 0.49 to 1.93; P = .93) instrumental delivery (RR, 0.94; 95% CI, 0.41 to 2.15; P = 0.89), and spontaneous delivery rate (RR, 1.02; 95% CI, 0.78 to 1.35; P = 0.87). Mothers treated with remifentanil have a higher patient satisfaction score. The use of remifentanil may be a good strategy for ECV. However, extrapolation of this finding to clinical settings must consider the study limitations.
摘要：
这项研究的目的是检查瑞芬太尼在臀位表现中对头颅外型（ECV）的疗效。使用PubMed进行了广泛的搜索，科克伦图书馆,和其他灰色文学。仅包括使用瑞芬太尼用于ECV的随机对照试验。使用风险比（RR）和平均差异（MD）来估计结果，并使用风险偏差和等级系统评估证据质量。分析了由602名患者组成的五项研究。瑞芬太尼导致ECV成功率适度增加(RR，1.19；95%CI，1.00至1.43；P=0.05），疼痛评分大幅降低(MD，-2.02；95%CI，-2.32至-1.72；P<.00001），短暂性胎儿心动过缓较少（RR，0.40；95%CI，0.19至0.85；P=.02）。然而,瑞芬太尼不影响剖宫产率，(RR,0.97；95%CI，0.49至1.93；P=.93）工具交付（RR，0.94；95%CI，0.41至2.15；P=0.89），和自发分娩率(RR，1.02；95%CI，0.78~1.35；P=0.87）。用瑞芬太尼治疗的母亲患者满意度评分更高。瑞芬太尼的使用可能是ECV的良好策略。然而,将这一发现外推到临床环境必须考虑研究的局限性.
