针刺联合椎管内镇痛在分娩镇痛中安全及有效性的meta分析  

Meta-analysis on the safety and efficacy of acupuncture combined with intraspinal analgesia in labor analgesia

作　　者：税林辉 何慧鑫[1] 彭赛 邓超文 滕永杰[1] 雷华娟[1] 李子奎 SHUI Linhui;HE Huixin;PENG Sai;DENG Chaowen;TENG Yongjie;LEI Huajuan;LI Zikui(Department of Anesthesiology,the First Hospital of Hu’nan University of Chinese Medicine,Hu’nan Province,Changsha410007,China;Department of Obstetrics,the First Hospital of Hu’nan University of Chinese Medicine,Hu’nan Province,Changsha410007,China)

机构地区：[1]湖南中医药大学第一附属医院麻醉科,湖南长沙410007 [2]湖南中医药大学第一附属医院妇产科,湖南长沙410007

出　　处：《中国医药导报》2021年第10期108-112,共5页China Medical Herald

基　　金：湖南省卫生健康委员会科研立项课题(20201389)。

摘　　要：目的系统评价针刺联合椎管内镇痛在分娩镇痛中的安全性及有效性。方法计算机检索PubMed、Embase、Cochrane Library、中国知网、万方、CBM和维普网,搜集针刺联合椎管内分娩镇痛的随机对照试验,检索时限均为建库至2020年8月。筛选出符合标准的文献,使用RevMan 5.3进行meta分析。结果共纳入10篇文献,包括872例患者。meta分析结果显示:试验组的阴道分娩转剖宫产率[OR=0.45,95%CI(0.26,0.77),P=0.003]、产后出血量[MD=-45.14,95%CI(-85.32,-4.96),P=0.03]及椎管内用药量[MD=-4.35,95%CI(-5.97,-2.74),P<0.00001]均低于对照组。但两组的宫口开全时视觉模拟评分[MD=-0.19,95%CI(-0.45,0.07),P=0.15]及第一产程活跃期时长[MD=-15.79,95%CI(-32.83,1.24),P=0.07]比较,差异无统计学意义。结论相较于单纯的椎管内分娩镇痛,针刺联合椎管内镇痛能减少椎管内用药量、产后出血量,降低阴道分娩转剖宫产率。但仍需大样本、多中心高质量的研究予以验证。Objective To systematically evaluate the safety and efficacy of acupuncture combined with intraspinal analgesia in labor analgesia.Methods The databases of PubMed,Embase,Cochrane Library,CNKI,Wanfang Data,CBM and VIP were searched by computer,and the randomized controlled trials of acupuncture combined with intraspinal labor analgesia were collected.The retrieval time was from the inception to August 2020.The literatures that met the criteria were screened and meta-analysis was carried out by RevMan 5.3.Results Ten literatures were included,including 872 patients.The results of meta-analysis showed that the conversion rate of vaginal delivery to cesarean section(OR=0.45,95%CI[0.26,0.77],P=0.003),postpartum hemorrhage volume(MD=-45.14,95%CI[-85.32,-4.96],P=0.03)and intraspinal drug dosage(MD=-4.35,95%CI[-5.97,-2.74],P<0.00001)in the experimental group were lower than those in the control group.However,there was no significant differences between the two groups in visual analogue scales of cervix with full open(MD=-0.19,95%CI[-0.45,0.07],P=0.15)and the time of active phase of the first stage of labor(MD=-15.79,95%CI[-32.83,1.24],P=0.07).Conclusion Compared with intraspinal labor analgesia,acupuncture combined with intraspinal analgesia can reduce the intraspinal drug dosage and postpartum hemorrhage volume,and reduce the rate of vaginal delivery to cesarean section.However,it still needs to be verified by large sample,multi-center and high quality studies.

关 键 词：针刺 分娩 镇痛 META分析 随机对照试验 

分 类 号：R714.3[医药卫生—妇产科学]