宫腔Bakri球囊填塞与宫腔纱布填塞治疗产后出血疗效和安全性的Meta分析  

Meta-analysis of efficacy and safety of intrauterine Bakri balloon tamponade and intrauterine gauze tamponade in the treatment of postpartum hemorrhage

作　　者：李华英 刘晖 黄赛玉 潘翠 LI Hua-ying;LIU Hui;HUANG Sai-yu;PAN Cui(Xiangtan Medical and Health Vocational and Technical College,Xiangtang 411102,Hunan,CHINA)

机构地区：[1]湘潭医卫职业技术学院

出　　处：《海南医学》2020年第3期388-394,共7页Hainan Medical Journal

基　　金：湖南省教育厅“十三五规划“科研课题(编号：18C1699);湖南省湘潭医卫职业技术学院教学教改研究项目校级重点项目

摘　　要：目的系统评价宫腔Bakri球囊填塞术与宫腔纱布填塞术抢救产后出血产妇的临床疗效和安全性。方法计算机检索The Cochrane Library、PubMed、EMbase、Web of Knowledge、CBM、WanFang Data和CNKI数据库,搜集宫腔Bakri球囊填塞术与宫腔纱布填塞术抢救产后出血产妇的临床随机对照研究,检索时限均为从建库至2019年1月。由两名研究员独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.3软件进行Meta分析。结果共纳入21个随机对照试验(RCT),共1762例患者。Meta分析结果显示:与纱布填塞组比较,Bakri球囊填塞手术抢救产后出血患者可提高止血成功率(OR=6.82,95%CI 4.18~11.12,P<0.00001),缩短操作时间(SMD=-4.58,95%CI-5.78^-3.39,P<0.00001)和住院时间(SMD=-1.24,95%CI-1.94^-0.53,P=0.0006),减少子宫动脉结扎率(OR=0.19,95%CI 0.12~0.32,P<0.00001)和子宫切除率(OR=0.17,95%CI 0.10~0.30,P<0.00001),减少感染率(OR=0.15,95%CI 0.04~0.60,P=0.007),球囊填塞术治疗24 h后血红蛋白值(SMD=1.87,95%CI 1.62~2.11,P<0.00001)高于纱布填塞,差异均有统计学意义。结论现有的证据表明,与宫腔纱布填塞手术相比,宫腔Bakri球囊填塞手术抢救产后出血产妇具有术中出血量少、住院时间短、术后并发症少等近期疗效优势。鉴于纳入研究数量有限,上述结论尚需开展更多研究予以验证。Objective To systematically evaluate the clinical efficacy and safety of uterine Bakri balloon tamponade and uterine gauze tamponade in the treatment of postpartum hemorrhage.Methods The search was performed in the Cochrane Library,PubMed,EMbase,Web of Knowledge,CBM,WanFang Data,and CNKI databases for clinical randomized controlled trials of intrauterine Bakri balloon tamponade and intrauterine gauze tamponade in the rescue of postpartum hemorrhage.The time range was from the establishment of the database to January 2019.RevMan 5.3 software was used for meta-analysis after two researchers independently screened literature,extracted data and evaluated the methodological quality of the study.Results A total of 21 randomized controlled trials(RCTs)were included,with a total of 1762 patients.Meta-analysis showed that compared with gauze tamponade group,Bakri balloon tamponade could improve the success rate of hemostasis(OR=6.82,95%CI 4.18 to 11.12,P<0.00001),shorten operation time(SMD=-4.58,95%CI-5.78 to-3.39,P<0.00001)and hospitalization time(SMD=-1.24,95%CI-1.94 to-0.53,P=0.0006),reduce uterine artery ligation rate(OR=0.19,95%CI 0.12 to 0.32,P<0.00001)and hysterectomy rate(OR=0.17,95%CI 0.10 to 0.30,P<0.00001)and reduce infection rate(OR=0.15,95%CI 0.04 to 0.60,P=0.007).The hemoglobin value of 24 hours after balloon tamponade was significantly higher than gauze tamponade(SMD=1.87,95%CI 1.62 to 2.11,P<0.00001).Conclusion The available evidences show that compared with gauze tamponade,Bakri balloon tamponade has the advantages of less intraoperative bleeding,shorter hospitalization time and fewer postoperative complications in the treatment of postpartum hemorrhage.In view of the limited number of studies included,more studies are needed to verify the above conclusions.

关 键 词：产后出血 球囊填塞术 纱布填塞术 META分析 系统评价 

分 类 号：R714.461[医药卫生—妇产科学]