两种椎管内分娩镇痛方法对剖宫产率影响的meta分析  

Comparison of cesarean section rate between two methods of intraspinal labor analgesia:A meta-analysis

作　　者：李鑫 崔春燕 刘洺含 张英 刘庆 LI Xin;CUI Chunyan;LIU Minghan;ZHANG Ying;LIU Qing(Department of Anesthesiology,Southwest Medical University,Luzhou 646000,China;Department of Pain,the Affiliated T.C.M Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学麻醉学系,泸州646000 [2]西南医科大学附属中医医院疼痛科,泸州646000

出　　处：《西南医科大学学报》2022年第1期54-58,共5页Journal of Southwest Medical University

基　　金：泸州市科技计划项目(2019-JYJ-64)。

摘　　要：目的通过比较腰硬联合与连续硬膜外两种分娩镇痛方法对剖宫产率的影响,为医务工作者选择最佳的分娩镇痛方法提供一定的依据。方法计算机检索中国知网(CNKI)、万方、维普(VIP)、中国生物医学文献(CBM)、PubMed、Embase等数据库从建库以来至2020年1月的所有腰硬联合与连续硬膜外用于分娩镇痛的随机对照实验(RCT)。对搜集的文献依据纳入和排除标准进行筛选,最后12篇文献纳入研究。用Cochrane质量评价工具行方法学质量评价,采用Revman5.3软件对最终纳入文献的主要结局指标剖宫产率及次要指标镇痛效果、产后出血量、总产程进行统计分析。结果纳入的12篇RCT,包括2266名产妇。Meta分析结果显示:腰硬联合组剖宫产率明显低于连续硬膜外组(RR=0.47,Z=6.24,P<0.05)、镇痛效果更好(RR=1.16,Z=6.52,P<0.05)、总产程缩短(MD=-1.41,Z=2.17,P<0.05),差异具有统计学意义,但对于产后出血量方面二者无统计学差异(MD=-21.67,Z=1.44,P>0.05)。结论现有证据表明,与连续硬膜外相比腰硬联合镇痛剖宫产率更低、镇痛效果更好、总产程缩短、产后出血无明显差异,腰硬联合用于分娩镇痛更有助于产妇顺产,减少不必要的剖宫产。Objective To provide a basis for medical workers to choose the best analgesic method for labor by comparing the ef⁃fect between combined spinal-epidural analgesia and continuous epidural analgesia on cesarean section rate.Methods A computerized search was performed in CNKI,Wanfang Data,VIP,CBM,PubMed,and EMBASE to identify all studies on randomized controlled trials(RCTs)of combined spinal-epidural analgesia versus continuous epidural analgesia during labor published up to January 2020.Finally,12 articles were included in the study according to the inclusion and exclusion criteria.The Cochrane quality assessment tool was used to assess the methodological quality,and RevMan 5.3 software was used to perform a statistical analysis of the primary outcome mea⁃sure,cesarean section rate,and the secondary outcome measures,analgesic efficacy,postpartum blood loss,and total labor time.Re-sults A total of 12 RCTs involving 2266 parturients were included in the analysis.The results of the meta-analysis showed that com⁃pared with the continuous epidural analgesia group,the combined spinal-epidural analgesia group had a significantly lower cesarean section rate(RR=0.47,Z=6.24,P<0.05),a significantly better analgesic effect(RR=1.16,Z=6.52,P<0.05),and a significantly shorter total labor time(MD=-1.41,Z=2.17,P<0.05),but there was no significant difference in postpartum blood loss between the two groups(MD=-21.67,Z=1.44,P>0.05).Conclusion Available evidence suggests that compared with continuous epidural anal⁃gesia,combined spinal-epidural analgesia has a lower rate of cesarean section,a better analgesic effect,and a shortened total labor time;there is no significant difference in postpartum hemorrhage;combined spinal-epidural analgesia in labor is more beneficial for vag⁃inal delivery,reducing unnecessary cesarean section.

关 键 词：腰硬联合镇痛 硬膜外镇痛 无痛分娩 剖宫产率 META分析 

分 类 号：R614.4[医药卫生—麻醉学]