硬膜外麻醉与经皮神经电刺激两种镇痛方法对分娩影响的Meta分析  

The Influence of Epidural Anesthesia and Percutaneous Electrical Stimulation on Delivery:A Meta-analysis

作　　者：剡淑霞 杨心茹 罗伟[1] 陈蕊娟 何荣霞[2] YAN Shu-xia;YANG Xin-ru;LUO Wei;CHEN Rui-juan;HE Rong-xia(The Second Clinical Medicine College of Lanzhou University,Lanzhou 730030,Chin;Lanzhou University Second Hospital,Lanzhou 730030,Chin)

机构地区：[1]兰州大学第二临床医学院,730030 [2]兰州大学第二医院

出　　处：《国际妇产科学杂志》2018年第4期287-293,共7页Journal of International Obstetrics and Gynecology

摘　　要：目的:系统评价硬膜外麻醉(EA)与经皮神经电刺激(TENS)两种镇痛方法对分娩的有效性与安全性。方法:通过计算机检索万方、百度学术、CNKI、维普、Elsevier、PubMed、Embase、Web of Science、Springer等数据库,收集自建库至2018年2月公开发表的关于EA与TENS两种镇痛分娩的随机对照试验,由2名研究者对收集文献依照纳入和排除标准进行独立筛选、提取和质量评价,采用RevMan 5.3软件对最终的纳入文献进行统计分析。结果:共纳入8篇文献1 715例研究对象,其中EA组868例、TENS组847例。Meta分析结果表明,与EA组比较,TENS组第一产程活跃期短(MD=-84.56,95%CI:-122.94～-46.17,P<0.000 1),第二产程短(MD=-14.03,95%CI:-21.75～-6.32,P=0.000 4),剖宫产率低(RR=0.78,95%CI:0.64～0.96,P=0.02),阴道助产率低(RR=0.49,95%CI:0.35～0.68,P<0.000 1),新生儿窒息发生率低(RR=0.54,95%CI:0.33～0.91,P=0.02)。但EA对重度疼痛的镇痛效果优于TENS(RR=8.78,95%CI:3.33～23.14,P<0.000 1)。结论:EA对重度疼痛缓解效果好,估计胎儿较大、患者疼痛剧烈时宜选择。TENS第一产程活跃期和第二产程短,剖宫产率、阴道助产率及新生儿窒息发生率低,对分娩影响小且无创,具有良好的临床应用前景。Objective：To evaluate the efficacy and safety of epidural anesthesia vs percutaneous electrical stimulation in delivery. Methods：Wanfang, Baidu, CNKI, VIP, Elsevier, PubMed, Embase, Web of Science, Springer database were searched to identify the randomized contro1 led trials on epidural anesthesia（EA） and transcutaneous electrical nerve stimulation（TENS）in delivery up to 2018 Feb. Two reviewers screened, extracted data and evaluated the study quality independently according to the inclusion and exclusion criteria. Review Manager（version 5.3） software was used to analyze the data. Results ：A total of1 715 subjects were included in 8 literatures, including 868 cases of EA group and 847 cases of TENS group. The results of systematic analysis showed that the active period of the first stage of labor in TENS group is shorter than that of EA group（MD=-84.56, 95%CI：-122.94～-46.17, P0.000 1）, the second stage of labor is shorter（MD=-14.03, 95%CI：-21.75～-6.32,P=0.000 4）, cesarean section rate is lower（RR=0.78, 95%CI： 0.64～0.96, P=0.02）, vaginal assisted delivery rate is lower（RR=0.49, 95%CI： 0.35～0.68, P0.000 1） and the incidence of newborns asphyxial are lower（RR=0.54, 95% CI： 0.33 ～0.91, P =0.02）, but the analgesic effect of EA on severe pain is better than that of TENS（RR=8.78, 95%CI： 3.33～23.14, P0.000 1）.Conclusions：Epidural anesthesia has better effect on severe pain relief. We should choose it when we doubt fetal macrosomia,patients with unbearable pain, while transcutaneous electrical stimulation has lesser side-effect on both mother and child,showing good clinical application prospects.

关 键 词：分娩 镇痛 经皮神经电刺激 麻醉 硬膜外 META分析 

分 类 号：R714.3[医药卫生—妇产科学]