不同干预措施对胎儿臀位/横位孕妇母婴结局影响的网状Meta分析  

Effects of Different Intervention Measures for Breech Presentation/Transverse Lie Position on Maternal and Neonatal Outcomes:a Network Meta-analysis

作　　者：王雪岩 田金徽[2] 张莉[3] 翟巾帼[1] WANG Xueyan;TIAN Jinhui;ZHANG Li;ZHAI Jinguo(School of Nursing,Southern Medical University/Evidence-Based Nursing and Midwifery Practice Center,Southern Medical University,Guangzhou 510515,China;Evidence-Based Medicine Center,Lanzhou University,Lanzhou 730099,China;Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学护理学院南方医科大学护理与助产循证中心,广东省广州市510515 [2]兰州大学循证医学中心,甘肃省兰州市730099 [3]南方医科大学南方医院,广东省广州市510515

出　　处：《中国全科医学》2023年第21期2647-2658,共12页Chinese General Practice

基　　金：2021年度广东省教育科学规划高等教育专项(2021GXJK163);2021年度南方医科大学质量工程建设项目-助产学课程教研室;广东省教育厅2019年度省级系列在线开放课程(20200304)。

摘　　要：背景胎儿臀位和横位如未得到及时、有效处理可能会增加剖宫产率,且增加子宫破裂等严重分娩并发症的风险,危及母胎生命。然而,对于不同干预措施的有效性对比与选择的优先次序,目前尚无统一结论。目的采用网状Meta分析方法,评价不同干预措施对孕晚期胎儿臀位/横位孕妇母婴结局的影响。方法计算机检索Cochrane Library、PubMed、Web of Science、Embase、CINAHL、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普网(VIP)、万方数据知识服务平台中关于不同干预措施对孕晚期胎儿臀位/横位孕妇母婴结局影响的随机对照试验(RCT),检索时间为建库至2022年3月。由2名研究人员独立完成文献筛选和资料提取,并进行文献质量评价。采用R 4.1.1和Stata 16.0软件进行数据分析和图形绘制,首先进行一致性检验与收敛性评估;通过累积排序概率图下面积(SUCRA)呈现不同措施成为最佳干预措施的可能。结果本研究共纳入36篇文献,包含7419名产妇。涉及的干预措施有:膝胸卧位、艾灸/刺激至阴穴和不同类型宫缩抑制剂/麻醉方式下实施外倒转术(ECV)。网状Meta分析结果显示,常规护理胎儿转为头位成功率低于艾灸/刺激至阴穴[RR=0.54,95%CI(0.32,0.86),P<0.05];无宫缩抑制剂胎儿转为头位成功率低于使用β2肾上腺素受体激动剂[RR=0.60,95%CI(0.38,0.62),P<0.05];无宫缩抑制剂、使用钙通道阻滞剂的阴道分娩率低于使用β2肾上腺素受体激动剂[RR=0.60,95%CI(0.39,0.89),P<0.05;RR=0.60,95%CI(0.39,0.95),P<0.05];ECV时无麻醉的胎儿转为头位成功率低于使用静脉麻醉[RR=0.71,95%CI(0.53,0.96),P<0.05]和椎管内麻醉[RR=0.65,95%CI(0.49,0.85),P<0.05];静脉麻醉、椎管内麻醉与不麻醉相比,可降低ECV后疼痛评分[WMD=-1.97,95%CI(-2.49,-1.46),P<0.05;WMD=-3.80,95%CI(-5.10,-2.50),P<0.05]。SUCRA排序结果显示,艾灸/刺激至阴穴、使用β2肾上腺素受体激动剂抑制宫缩、在�Background Untimely and ineffectively treated breech or transverse lie position of a fetus may increase the rate of cesarean section,and the risk of uterine rupture and other serious childbirth complications,endangering the lives of mothers and newborns.However,at present,there is no conclusion on the effectiveness and selection priority of different interventions for it during childbirth.Objective To perform a network meta-analysis of the impact of different interventions for breech or transverse lie position on maternal and neonatal outcomes.Methods We searched the Cochrane Library,PubMed,Web of Science,Embase,CINAHL,CBM,CNKI,VIP,and Wanfang Data Knowledge Service Platform for randomized controlled trials(RCTs)of the effects of different interventions for breech or transverse lie position on maternal and neonatal outcomes from inception to March 2022.Two researchers independently completed literature screening and data extraction,and quality assessment.R 4.1.1 and Stata 16.0 were used for data analysis and graph drawing.Consistency test and convergence analysis of the studies were performed.SUCRA was used to rank the effectiveness of each intervention and determine the most effective one.Results A total of 36 RCTs were included,including 7419 parturients.The interventions involved were:knee-chest position,moxibustion/stimulation of Zhiyin acupoint,and external cephalic version(ECV)under different types of uterine contraction inhibitors/anesthesia.Network meta-analysis showed that compared with moxibustion/stimulation to Zhiyin acupoint,the success rate of moving a breech or transverse lie position to a head position was lower by usual nursing〔RR=0.54,95%CI(0.32,0.86),P<0.05〕.The success rate of moving a breech or transverse lie position to a head position without uterine contraction inhibitor before ECV was lower than that usingβ2-adrenergic receptor agonists〔RR=0.60,95%CI(0.38,0.62),P<0.05〕.The vaginal delivery rate with calcium channel blockers but without uterine contraction inhibitors was lower tha

关 键 词：臀先露 横位 胎产式 母婴结局 妇幼保健服务 助产 网状Meta分析 

分 类 号：R714.44[医药卫生—妇产科学]