会阴无保护联合硬膜外镇痛分娩用于初产妇阴道分娩效果的Meta分析  

Effect of unprotected perineum combined with epidural analgesia for vaginal delivery in primipara:a meta-analysis

作　　者：樊薇[1] 李海鸿[1] 魏兰香 张翰儒[1] 于英 FAN Wei;LI Haihong;WEI Lanxiang;ZHANG Hanru;YU Ying(Childbirth Center,Maternal and Child Health Hospital of Gansu Province,Gansu 730050 China)

机构地区：[1]甘肃省妇幼保健院,730050

出　　处：《全科护理》2023年第15期2017-2023,共7页Chinese General Practice Nursing

基　　金：甘肃省自然科学基金项目,编号:20JR5RA134;兰州市科技发展指导性计划项目,编号:2020-ZD-9。

摘　　要：目的:系统评价会阴无保护联合硬膜外镇痛分娩在初产妇阴道分娩中的效果。方法:计算机检索中国知网(CNKI)、万方数据库(WanFang Deta)、维普(VIP)、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Cochrane Library、EBSCO中关于会阴无保护联合硬膜外镇痛分娩的随机对照试验,检索时限为建库至2022年1月。采用RevMan 5.3软件对结局指标进行分析。结果:Meta分析结果显示会阴无保护联合硬膜外镇痛分娩可降低会阴Ⅰ度裂伤[OR=0.63,95%CI(0.50,0.80),P<0.000 1]、会阴Ⅱ度裂伤[OR=0.38,95%CI(0.28,0.52),P<0.000 01]发生率;缩短第二产程[MD=-5.02,95%CI(-6.69,-3.34),P<0.000 01];减少产后0度盆底脱垂的发生[OR=1.81,95%CI (1.35,2.44),P<0.000 1],尤其Ⅱ度脱垂[OR=0.19,95%CI(0.12,0.30),P<0.000 01];减少产后伤口愈合[OR=0.37,95%CI(0.21,0.68),P=0.001]、产褥感染[OR=0.35,95%CI(0.18,0.69),P=0.002]、产后尿潴留[OR=0.43,95%CI(0.23,0.82),P=0.01]、产后疼痛[OR=0.22,95%CI(0.09,0.55),P=0.001]等并发症的发生。结论:会阴无保护接生联合硬膜外镇痛可以减少会阴裂伤缩短第二产程,降低产后盆底脱垂并发症的发生率。Objective:To systematically review the effect of unprotected perineum combined with epidural analgesia in primipara vaginal delivery.Methods:Randomized controlled trials related to perineum unprotected joint hard of external analgesia in childbirth were retrieved from China National Knowledge Infrastructure(CNKI),WanFang Database,VIP Database,China Biomedical Literature Database(CBM),PubMed,Web of Science,Cochrane Library,and EBSCO from the establishment of the database to January 2022.The outcome indicators were analyzed using Revman 5.3 software.Results:The meta-analysis results showed that unprotected perineum combined with epidural analgesia could reduce the incidence rate of first-degree perineal laceration[OR=0.63,95%CI(0.50,0.80),P<0.0001]and second-degree perineal laceration[OR=0.38,95%CI(0.28,0.52),P<0.00001];shorten the second stage of labor[MD=-5.02,95%CI(-6.69,-3.34),P<0.00001];reduce the postpartum occurrence of pelvic floor prolapse[OR=1.81,95%CI(1.35,2.44),P<0.0001],especially second-degree prolapse[OR=0.19,95%CI(0.12,0.30),P<0.00001];reduce the incidence of postpartum wound healing[OR=0.37,95%CI(0.21,0.68),P=0.001],puerperal infection[OR=0.35,95%CI(0.18,0.69),P=0.002],postpartum urinary retention[OR=0.43,95%CI(0.23,0.82),P=0.01],postpartum pain[OR=0.22,95%CI(0.09,0.55),P=0.001],and other complications.Conclusions:Unprotected perineal delivery combined with epidural analgesia can reduce perineal laceration,shorten the second stage of labor,and reduce the incidence of postpartum pelvic floor prolapse complications.

关 键 词：会阴无保护 硬膜外镇痛 初产妇 META分析 

分 类 号：R714.3[医药卫生—妇产科学]