毒理性
◉ 母乳喂养期间使用总结：卷心菜（Brassica oleracea）叶被外用贴在乳房上，以治疗乳房充血作为治疗乳腺炎的辅助手段。一些研究者切掉叶子上的一个洞以保持乳头干燥。叶子被冷冻、冷藏或常温下使用。各项研究发现，无论温度如何，卷心菜叶都有助于减少乳房充血和疼痛。然而，一项元分析得出结论，没有充分的证据表明外用卷心菜叶比不治疗更好，因为充血往往会随着时间的推移而改善，无论治疗与否。作者认为这种干预措施便宜，不太可能造成伤害，可能会让母亲感到舒缓。另一项系统评价得出结论，没有证据表明冷卷心菜叶可以减少乳房充血，但它们确实可以减少乳房疼痛。婴儿不受限制地哺乳可能是减少充血的重要因素。一些低质量的证据表明，母亲食用卷心菜可能会导致她们的母乳喂养婴儿发生绞痛。
◉ 对母乳喂养婴儿的影响：在乳房上外用卷心菜叶后没有报告任何副作用。研究了母亲食用卷心菜作为母乳喂养婴儿发生绞痛的可能原因。向哺乳的母亲发送了一份问卷，询问她们在过去一周的食物摄入量和她们的婴儿在这一时期绞痛的症状。在上一周报告婴儿发生绞痛的73位母亲中，有30%在这段时间内吃过卷心菜，比上一周没有发生绞痛的婴儿的母亲更有可能。此外，许多其他母亲报告避免食用十字花科蔬菜（例如西兰花、卷心菜、花椰菜），因为她们将这些食物归因于以前母乳喂养婴儿的绞痛症状。
◉ 对泌乳和母乳的影响：在一项随机、非盲的研究中，对在医院住院的产后妇女在母乳喂养期间乳房充血的情况进行了研究，一组使用冷藏的卷心菜叶贴在乳房上（n = 59），另一组接受常规医院护理（n = 56）。使用卷心菜叶的母亲纯母乳喂养的时间比没有使用的母亲稍微长一些（36天对30天）。在产后6周时，两组之间母乳喂养的母亲百分比没有统计学差异。作者认为，任何差异最可能是由母亲的心理机制造成的，而不是卷心菜叶。这项研究因20%的随访丢失而受到影响。
一项研究调查了在不同温度下使用卷心菜叶治疗住院产后妇女乳房充血的情况（n = 28）。每位母亲随机顺序地将冷藏的叶子贴在一个乳房上，将常温的叶子贴在另一个乳房上。两种治疗都减轻了感觉到的乳房疼痛，但在减轻充血疼痛方面，冷藏和常温的卷心菜叶之间没有发现差异。
一项研究比较了冷藏卷心菜叶和冷凝胶包在住院产后妇女治疗乳房充血的效果（n = 33）。两种方法都在乳头周围切出了空隙。受影响的妇女每隔2到4小时按需在一个乳房上贴上卷心菜叶，在另一个乳房上贴上凝胶包。在减轻乳房疼痛方面，卷心菜叶和凝胶包之间没有差异。
一项随机、双盲的研究比较了一种含有卷心菜提取物的乳膏（n = 21）与安慰剂乳膏（n = 18）治疗乳房充血的效果。这种乳膏是特别为研究制作的，含有1%的卷心菜提取物，根据英国药典的方法，与安慰剂乳膏的基料相同。母亲评估她们的疼痛和乳房硬度，研究人员使用一种设备来测量乳房硬度。两种治疗都改善了我们测量的所有参数，两者之间没有差异。哺乳婴儿比任何一种乳膏更能减轻不适感和乳房组织的硬度。
一项研究比较了交替冷热敷（n = 30）与冷冻卷心菜叶（n = 30）治疗乳房充血的效果。该研究没有随机分组或盲法。每种治疗每天3次，每次30分钟，持续2天。结果使用乳房充血和疼痛量表来判断，尽管不清楚评分是由谁进行的。两种治疗都有效地减轻了疼痛和充血。作者得出结论，冷热敷比卷心菜叶更有效，但这种结论并没有得到研究设计的支持。
一项在30名乳房充血的妇女中进行的不受控制的试点研究比较了在她们将冷藏的卷心菜叶贴在乳房上每天两次，每次15到20分钟，持续3天前后的疼痛评分。3天后的充血评分低于研究开始时。
在韩国进行的一项小型、非随机、非盲的研究比较了初产妇在剖宫产后早期乳房护理时是否在乳房上使用冷藏卷心菜叶和一般护理的效果。使用压力传感器客观测量乳房硬度，结果显示，在产后第2、3和4天，接受卷心菜叶的母亲乳房硬度较低，但主观疼痛评分没有差异。
一项随机、非盲的试验比较了冷卷心菜叶、冷凝胶包和无治疗在228名乳房充血的妇女中的效果。所有患者都接受了常规护理。接受卷心菜叶
◉ Summary of Use during Lactation:Cabbage (Brassica oleracea) leaves have been applied topically to the breasts to treat breast engorgement and as an adjunct to treatment of mastitis. Some investigators cut out a hole in the leaves to keep the nipples dry. Leaves have been applied frozen, refrigerated or at room temperature. Various studies found cabbage leaves beneficial for reducing breast engorgement and pain regardless of temperature. However, a meta-analysis concluded that there is no good evidence that topical cabbage leaves were better than no treatment, because engorgement tends to improve over time regardless of treatment. The authors felt that the intervention was cheap, unlikely to cause harm and might be soothing for the mother. Another systematic review concluded that no evidence exists for cold cabbage leaves decreasing breast engorgement, but that they do decrease breast pain. Unrestricted nursing of the infant may be an important factor in reducing engorgement. Some low-quality evidence indicates that maternal cabbage ingestion might cause colic in their breastfed infants.
◉ Effects in Breastfed Infants:No side effects have been reported after topical application of cabbage leaves to the breast. Maternal cabbage intake was studied as a possible cause of colic in breastfed infants. A questionnaire was sent to nursing mothers asking about food intake during the previous week and their infants' symptoms of colic during that time. Seventy-three mothers who reported colic in their infants during the prior week were 30% more likely to have eaten cabbage during this time than mothers of infants who did not have colic during the previous week. Additionally, many other mothers reported avoiding cruciferous vegetables (e.g., broccoli, cabbage, cauliflower) because of previous symptoms of colic in their breastfed infants that they attributed to these foods.
◉ Effects on Lactation and Breastmilk:In a randomized, nonblinded study, postpartum hospitalized women with breast engorgement during breastfeeding either applied refrigerated cabbage leaves to their breasts (n = 59) or received routine hospital care (n = 56). The women who used the cabbage leaves breastfed exclusively for slightly longer than those who did not (36 vs 30 days). At 6 weeks postpartum, there was no statistical difference in the percentage of women breastfeeding between the two groups The authors felt that any difference was most likely caused by psychological mechanisms in the mothers than the cabbage leaves. This study suffered from a 20% loss to follow-up.
A study investigated cabbage leaves at different temperatures in the treatment of breast engorgement in hospitalized postpartum women (n = 28). Each mother received chilled leaves to one breast and room temperature leaves to the other in a randomized order. Both treatments reduced perceived breast pain, but no difference was found between the chilled and room temperature cabbage leaves in reducing the pain of engorgement.
A study compared chilled cabbage leaves to cold gelpacks in the treatment of breast engorgement in hospitalized postpartum women (n = 33). Both had cutout areas around the nipple. Affected women applied a cabbage leaf to one breast and the gelpack to the other as needed at 2- to 4-hour intervals. There was no difference in the breast pain reduction between the cabbage leaves and gelpacks.
A randomized, double-blind study compared a cream containing cabbage extract (n = 21) to a placebo cream (n = 18) for treating breast engorgement. The cream was specially made for the study using a 1% cabbage extract according to the methods of the British Pharmacopoeia and the same cream base as the placebo. Mothers rated their pain and breast firmness, and a device was used by researchers to measure breast firmness. Both treatments improved all measured parameters, with no difference between the two treatments. Nursing the infant had a greater effect on perceptions of discomfort and the hardness of the breast tissue than either of the creams.
A study compared the effectiveness of topical use of alternating cold and hot compresses (n = 30) to frozen cabbage leaves (n = 30) for the treatment of breast engorgement. The study was not randomized or blinded. Each treatment was applied for 30 minutes 3 times daily for 2 days. Outcomes were judged using breast engorgement and pain scales, although it is unclear who did the rating. Both treatments were effective in reducing pain and engorgement. The authors concluded that hot and cold compresses were more effective than cabbage leaves, but this conclusion is not justified by the study design.
An uncontrolled pilot study in 30 women with breast engorgement compared pain scores before and after the mothers applied refrigerated cabbage leaves to their breasts twice daily for 3 days for 15 to 20 minutes. Engorgement scores were lower after 3 days than at the beginning of the study.
A small, nonrandomized, nonblinded study in Korea compared early breast care with and without chilled cabbage leaves applied to the breast and general nursing breast care in primiparous mothers after cesarean section. Breast hardness, as measured objectively with a pressure sensor, was lower on days 2, 3 and 4 postpartum in the mothers who received the cabbage leaves, but no difference in subjective pain scores was seen.
A randomized, nonblinded trial compared cold cabbage leaves to cold gel packs and no treatment in 228 women with breast engorgement. All patients received routine care. Mothers in the cabbage group reported being slightly more satisfied with treatment than those in the other groups. No difference was found in the rates of breastfeeding between groups at 3 and 6 months postpartum.
来源:Drugs and Lactation Database (LactMed)
