会阴按摩对产时会阴损伤影响的Meta分析  

Effect of Perineal Massage on Preventing Perineal Trauma in Childbirth:A Meta-analysis

作　　者：曾丽华[1] 张爱霞[1] 朱珠[1] 陈琴 叶敏[1] 刘晓[1] 王义婷 ZENG Li-hua;ZHANG Ai-xia;ZHU Zhu;CHEN Qin;YE Min;LIU Xiao;WANG Yi-ting(Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属妇产医院,江苏南京210029

出　　处：《护理学报》2018年第13期46-51,共6页Journal of Nursing（China）

基　　金：南京市医学科技发展项目(YKK15157)

摘　　要：目的采用Meta分析评价会阴按摩对预防分娩时会阴损伤的影响。方法计算机检索PubMed、CINAHL、Web of Science、中国知网、万方数据库相关文献,检索时间为1950年1月—2018年3月。根据纳入标准查找会阴按摩对分娩时会阴结局影响文献,采用Rev Man 5.3软件对文献数据进行分析。结果最终共纳入14项研究,共纳入病例数6 119例。分为妊娠晚期会阴按摩初产妇组,妊娠晚期会阴按摩经产妇组及分娩期会阴按摩初产妇组3个亚组进行分析,分析结果示:妊娠晚期会阴按摩保持初产妇会阴完整性的作用和分娩时会阴按摩预防初产妇3度以上会阴撕裂的发生率,差异有统计学意义;统计值分别是[RR:1.43,95%CI(1.28,1.61),P<0.00001];[RR:0.45,95%CI(0.23,0.89),P=0.02]。在人群亚组分析结果显示:妊娠晚期会阴按摩对经产妇的会阴完整[RR:1.08,95%CI(0.84,1.39)]、会阴侧切率[RR:0.83,95%CI(0.51,1.35)]、会阴1度撕裂[RR:1.03,95%CI(0.67,1.59)]、2度撕裂[RR:0.98,95%CI(0.73,1.31)]及3度以上会阴撕裂[RR:0.51,95%CI(0.05,5.67)]差异均无统计学意义;妊娠晚期会阴按摩对初产妇的会阴侧切率[RR:0.97,95%CI(0.79,1.18)]、会阴1度撕裂[RR:1.01,95%CI(0.82,1.25)]、2度撕裂[RR:0.95,95%CI(0.78,1.14)]及3度以上会阴撕裂[RR:0.86,95%CI(0.62,1.18)];分娩时会阴按摩对初产妇的会阴侧切率[RR:0.84,95%CI(0.68,1.04)]、会阴完整率[RR:1.03,95%CI(0.87,1.23)]及会阴1度撕裂[RR:1.13,95%CI(0.89,1.42)]、2度撕裂[RR:1.04,95%CI(0.88,1.25)]均无统计学意义。结论妊娠晚期会阴按摩有利于保持初产妇会阴的完整性,分娩时会阴按摩可预防初产妇的严重会阴撕裂,但妊娠晚期会阴按摩对降低初产妇会阴侧切率和预防1度、2度会阴撕裂;对保持经产妇的会阴完整性及预防会阴撕裂作用效果不明显。Objective To evaluate the effect of perineal massage on the prevention of perineum trauma in childbirth with Meta analysis. Methods We retrieved literatures published between January 1950 and March 2018 from Pubmed, CINAHL, Web of Science,CNKI and Wang Fang databases on the effect of perineal massage on the prevention of perineum trauma in childbirth. Then, two evaluators extracted the relevant data from the involved literatures, assessed the methodological quality of the articles, and analyzed the data with Rev Man 5.3 software. Results Totally 14 studies including 6,119 cases was involved. We divided the literatures into three subgroups：primiparas with perineal massage during late pregnancy group（group A）, multiparas with perineal massage during late pregnancy group（group B）, and primiparas with perineal massage during labour group（group C）. The results showed that perineal massage can maintain the integrity of perineum during labour and the differences between group A and C were significant [RR： 1.43, 95%CI（1.28,1.61）, P〈0.00001）and perineal massage can decease the incidence of third-or fourth-degree of laceration of perineum, which indicated statistical significance[RR： 0.45,95%CI（0.23, 0.89）, P=0.02]. But the effect of perineal massage for multiparas during late pregnancy on maintaining the perineum integrity [RR：1.08,95% CI（0.84,1.39）] and the episiotomy rate [RR：0.83,95% CI（0.51,1.35）], first degree perineal tear[RR：1.03,95%CI（0.67,1.59）],second degree perineal tear[RR：0.98, 95%CI（0.73,1.31）] and third-or fourth-degree of laceration of perineum [RR：0.51,95%CI（0.05,5.67）] were not statistically significant. The effect of perineal massage for primiparas during late pregnancy on the episiotomy rate[RR：0.97,95%CI（0.79,1.18）], first degree perineal tear [RR：1.01,95%CI（0.82,1.25）], second degree perineal tear[RR：0.95,95%CI（0.78,1.14）] and third-or fourth-degree of laceration of perineum[RR：0.86,95%CI（0.62,1.18）] were not statisti

关 键 词：会阴按摩 会阴损伤 META分析 

分 类 号：R473.71[医药卫生—护理学]