卡贝缩宫素和缩宫素比较预防阴道分娩产后出血有效性和安全性的Meta分析  

The efficacy and safety of carbetocin versus oxytocin on the prevention of postpartum hemorrhage for women undergoing vaginal delivery: a meta-analysis

作　　者：谭雅卿 刘树俊 曹世钰 王婷婷[1] 陈立章[1] TAN Yaqing;LIU Shujun;CAO Shiyu;WANG Tingting;CHEN Lizhang(Department of Epidemiology and Health Statistics,School of Xiangya Public Health,Central South University,Changsha,410078,P.R.China)

机构地区：[1]中南大学湘雅公共卫生学院流行病与卫生统计学系,长沙410078

出　　处：《中国循证医学杂志》2018年第10期1093-1100,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价卡贝缩宫素和缩宫素比较预防阴道分娩产后出血的有效性和安全性。方法计算机检索PubMed、The Cochrane Library、Web of Science、CBM、WanFang Data、CNKI和VIP数据库,搜集有关卡贝缩宫素和缩宫素比较预防阴道分娩产后出血的随机对照试验(RCT),检索时限均从建库至2018年1月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件及Stata 12.0软件进行Meta分析。结果共纳入16个RCT,包括2 537名患者。Meta分析结果显示:与缩宫素相比,卡贝缩宫素可减少产后24h出血量[MD=–107.68,95%CI(–130.21,–85.15),P<0.000 01]、产后2h出血量[MD=–85.98,95%CI(–93.37,–78.59),P<0.000 01]、产后24h血红蛋白下降值[MD=–5.63,95%CI(–6.82,–4.43),P<0.000 01]、产后出血发生率[RR=0.46,95%CI(0.32,0.66),P<0.000 01]和额外宫缩剂使用率[RR=0.63,95%CI(0.48,0.84),P=0.002]。两组的不良反应发生率差异无统计学意义。结论当前证据表明,卡贝缩宫素对经阴道分娩产后出血的预防效果优于普通缩宫素,且不增加不良反应发生。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。Objectives To systematically review the efficacy and safety of carbetocin versus oxytocin on the prevention of postpartum hemorrhage（PPH） for women undergoing vaginal delivery. Methods PubMed, The Cochrane Library, Web of Science, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials（RCTs） on carbetocin versus oxytocin on the prevention of PPH for women undergoing vaginal delivery from inception to January 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 12.0 software.Results A total of 16 RCTs including 2 537 patients were included. The results of meta-analysis showed that： compared to oxytocin, carbetocin could reduce the amount of blood loss within 24 h（MD=–107.68, 95%CI–130.21 to –85.15,P〈0.000 01） and 2 h（MD=–85.98, 95%CI–93.37 to –78.59, P〈0.000 01）, hemoglobin（Hb） within 24 h after delivery（MD=–5.63, 95%CI–6.82 to –4.43, P〈0.000 01）, the occurrence of PPH（RR=0.46, 95%CI 0.32 to 0.66, P〈0.000 01） and the requirement for additional uterotonic agents（RR=0.63, 95%CI 0.48 to 0.84, P=0.002）. There was no significant difference in the risk of adverse effects between two groups. Conclusions Current evidence shows that carbetocin is superior to oxytocin in the prevention of PPH for women undergoing vaginal delivery, without increasing the adverse effects. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above the conclusion.

关 键 词：卡贝缩宫素 缩宫素 阴道分娩 产后出血 系统评价 META分析 随机对照试验 

分 类 号：R714.461[医药卫生—妇产科学]