腰硬联合麻醉用于剖宫产有效性及安全性的系统评价  

Effectiveness and Safety of Combined Spinal-Epidural Anesthesia in Cesarean Section: A Systematic Review

作　　者：刁敏[1] 柳慧[1] 林雪梅[1] 

机构地区：[1]四川大学华西第二医院麻醉科,成都610041

出　　处：《中国循证医学杂志》2014年第10期1218-1224,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价腰硬联合麻醉用于剖宫产的有效性和安全性。方法计算机检索The Cochrane Library(2013年第10期)、PubMed、MEDLINE、EMbase、CBM、CNKI、VIP和WanFang Data,纳入腰硬联合麻醉用于剖宫产的随机对照试验(RCT),检索时限截至2013年10月。由2位研究者独立按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2.9软件进行Meta分析。结果共纳入9个RCT,616例产妇。Meta分析结果显示,与单纯硬膜外麻醉相比,腰硬联合麻醉在感觉阻滞平面到达T4的时间[MD=–7.38,95%CI(–9.54,–5.23),P<0.00001]、肌松效果[OR=6.09,95%CI(2.65,13.97),P<0.0001]和运动阻滞恢复时间[MD=–41.57,95%CI(–58.98,–24.17),P<0.00001]方面效果更好;与腰麻比较,腰硬联合麻醉的低血压发生率更低[OR=0.49,95%CI(0.29,0.81),P=0.006]。结论现有证据显示,腰硬联合麻醉能显著提高剖宫产的有效性和安全性。Objective To systematically review the effectiveness and safety of combined spinal-epidural anesthesia for cesarean section. Methods We searched The Cochrane Library （Issue 10, 2013）, PubMed, MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data for randomized controlled trials on combined spinal-epidural anesthesia for cesarean sec- tion up to October 2013. Two reviewers independently screened literature according to the inclusion and exclusion crite- ria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was conducted using RevMan 5.2.9 software. Results A total of 9 studies containing 616 delivery women were included. The results of meta- analysis showed that： compared with epidural anesthesia, combined spinal-epidural anesthesia was superior in the time of sensory blockade to T4 （MD=-7.38, 95%CI -9.54 to -5.23, P〈0.000 01）, muscle relaxation （OR=6.09, 95%CI 2.65 to 13.97, P〈0.000 1）, and recovery of motor block （MD= -41.57, 95%CI -58.98 to -24.17, P〈0.000 01）. Compare with spinal anesthesia, combined spinal-epidural anesthesia was superior in lowering the incidence of low blood pressure （OR=0.49, 95%CI 0.29 to 0.81, P=0.006）. Conclusion Current evidence shows that combined spinal-epidural anesthesia could in- crease the effectiveness and safety of combined spinal-epidural anesthesia for cesarean section.

关 键 词：腰硬联合麻醉 剖宫产术 系统评价 META分析 随机对照试验 

分 类 号：R614[医药卫生—麻醉学]