缩宫素预防产后出血的高风险因素Meta分析  

Risk of oxytocin for prevention of postpartum hemorrhage： a Meta analysis

作　　者：孙世光[1] 李阳[2] 闫荟[1] 石亚飞[2] 

机构地区：[1]北京军区总医院第二门诊部,100700 [2]河北北方学院研究生部

出　　处：《中国医药》2014年第10期1530-1534,共5页China Medicine

基　　金：北京市科技计划课题（Z131100004013007）

摘　　要：目的 分析缩宫素预防产后出血使用中的风险归属和高风险因素排序.方法 检索2009年1月至2013年7月中国知网（CNKI）以及CNKI网络资源共享平台中资源总库中的源数据库公开发表的期刊论文及学位论文中关于缩宫素预防产后出血的临床回顾性研究文献,采用RevMan 5.1软件,按照用药剂量、用药途径及合并用药分别对缩宫素使用中的不良反应发生率进行Meta分析,对不能进行Meta分析的文献进行描述性分析,得出缩宫素使用中的风险归属.结果 符合标准的35篇文献纳入研究,其中与用药剂量相关的1篇,与用药途径相关的2篇,与合并用药相关的32篇.Meta分析结果显示,大剂量（剂量＞10 U）使用缩宫素风险性较高[比值比（OR）=0.20,95％置信区间（CI）：0.08～0.48,P=0.00],合并用药（OR=1.65,95％ CI：0.97 ～2.79）,P=0.07）和静脉给药（OR =0.18,95％ CI：0.01 ～3.16,P=0.27）增加缩宫素使用风险的差异无统计学意义.缩宫素与卡前列甲酯、卡前列素氨丁三醇、益母草、葡萄糖酸钙、地诺前列酮联合使用过程中,可在一定程度上降低药物不良反应的发生.米索前列醇与缩宫素联合使用,很大程度上增加了药物不良反应的发生率（OR =2.87,95％ CI：1.38 ～5.96,P=0.00）,文献异质性分析差异无统计意义（P＜0.01）.结论 缩宫素在预防产后出血使用中的高风险因素排序为用药剂量高于合并用药,合并用药高于用药途径.缩宫素在预防产后出血使用中大剂量（剂量＞10 U）使用时,药物不良反应发生率较高;米索前列醇联合缩宫素使用时,可增加用药风险.Objective To analyze the risk of oxytocin in the prevention of postpartum hemorrhage.Methods The clinical retrospective study literatures were retrieved in CNKI.These journal articles and dissertations were all about oxytocin for preventing postpartum hemorrhage.These literatures were divided into three different classes （dosage,route of administration and combination therapy）.The data of adverse events from the literatures was processed by the RevMan 5.1.The risks of using oxytocin for the three classes were analyzed.Results Thirty-five documents in accordance with the standards were included in the study.One article was related to dosage;two articles were associated with the route of administration,and others were associated with the combination therapy.The occurrence of adverse drug reactions for oxytocin was related to the use of high doses（doses 〉 10 U） （OR =0.20,95 % CI：0.08-0.48,P =0.0003） and the combination of Misoprostol （OR =2.87,95% CI：1.38-5.96,P =0.005）.Combined medication for general conditions（OR =1.65,95% CI：0.97-2.79）,P =0.07） and intravenous administration （OR =0.18,95 % CI：0.01-3.16,P =0.27） were not associated with the increase of adverse reactions.Conclusions High doses use and the combination of Misoprostol for oxytocin are the risk factors of adverse reactions.Combination medication for general conditions and the intravenous administration of oxytoein are not confirmed as risk factors.

关 键 词：缩宫素 产后出血 高危药品 META分析 

分 类 号：R714.461[医药卫生—妇产科学]