抗菌药物预防经阴道分娩产后感染效果的系统评价再评价  

Efficacy of antimicrobials in the prevention of postpartum infection after vaginal delivery:overview of systematic reviews

作　　者：李小让 张家兴[2] 赵华叶 张瑞 胡鳞方 王家雪 蓝俊杰 孙水梅 谭松松 曹金永 LI Xiaorang;ZHANG Jiaxing;ZHAO Huaye;ZHANG Rui;HU Linfang;WANG Jiaxue;LAN Junjie;SUN Shuimei;TAN Songsong;CAO Jinyong(College of Pharmacy,Guizhou University of Traditional Chinese Medicine,Guiyang 550002,P.R.China;Department of Pharmacy,Guizhou Provincial People's Hospital,Guiyang 550002,P.R.China;Medical Insurance Department,Guizhou Provincial People's Hospital,Guiyang 550002,P.R.China;Department of Endoscopy,Guizhou Provincial People's Hospital,Guiyang 550002,P.R.China)

机构地区：[1]贵州中医药大学药学院,贵阳550002 [2]贵州省人民医院药剂科,贵阳550002 [3]贵州省人民医院医保处,贵阳550002 [4]贵州省人民医院内镜科,贵阳550002

出　　处：《中国循证医学杂志》2024年第3期303-311,共9页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金项目(编号:72064004);贵州省卫生健康委科学技术基金项目(编号:gzwkj2022-224、gzwkj2021-553);贵州省中医药民族医药科学技术项目(编号:QZYY-2023-042)。

摘　　要：目的对抗菌药物预防经阴道分娩产后感染的效果和安全性进行系统评价再评价,为经阴道分娩女性使用抗菌药物预防感染提供证据支持。方法计算机检索CNKI、WanFang Data、VIP、PubMed、Embase和Cochrane Library数据库,搜集有关抗菌药物预防经阴道分娩产后感染的系统评价,检索时限均为建库至2023年6月25日。由2名研究者独立对纳入的系统评价进行资料提取,并采用AMSTAR 2.0量表、ROBIS工具、PRISMA对其方法学质量、偏倚风险、报告质量进行评估。同时提取结局指标建立评价抗菌药物预防经阴道分娩产后感染的结局指标条目池。结果共纳入7项系统评价。AMSTAR 2.0评价结果显示:2项研究为中质量,3项为低质量,2项为极低质量。ROBIS评价结果显示:3项研究为低偏倚风险,3项为高偏倚风险,1项偏倚风险为不确定。PRISMA声明结果显示:纳入的系统评价报告整体较完整。当前系统评价证据显示:Ⅲ~Ⅳ度会阴裂伤的女性预防使用抗菌药物可能是有益的和被推荐的;手取胎盘的女性无明显获益,但考虑其存在侵入性操作而推荐预防使用抗菌药物;但是阴道助产、会阴侧切术、自然分娩(无并发症)这几类人群是否应使用抗菌药物是存在争议的。结局指标的研究结果显示:目前评价抗菌药物预防经阴道分娩产后感染的结局指标尚不统一。结论并非所有的经阴道分娩产妇都建议预防性使用抗菌药物预防产后感染。因该领域系统评价的质量还需进一步提升,且尚无统一的结局指标评价抗菌药物预防产后感染的效果,所以该领域还有待开展高质量的研究来进一步验证。Objective To overview of systematic reviews of the efficacy and safety of antimicrobials in the prevention of postpartum infection after vaginal delivery,and to provide evidence for the rational use of antimicrobials.Methods The CNKI,WanFang Data,VIP,PubMed,Embase,and Cochrane Library databases were searched to collect systematic reviews/meta-analyses on antibiotic prophylaxis for transvaginal delivery from inception to June 25,2023.The data of the included systematic reviews were extracted by 2 investigators independently,and the methodological quality,risk of bias,and report quality were evaluated by AMSTAR 2.0 scale,ROBIS tool,and PRISMA,respectively.And a pool of outcomes for assessing the effectiveness of antimicrobials in prevention of postpartum infection after transvaginal delivery was developed.Results A total of 7 systematic reviews were included.And the AMSTAR 2.0 indicated that most studies(5/7)were from very low quality to low quality.The ROBIS tool showed 3 studies with low risk of bias,3 with high risk of bias,and 1 with unclear risk of bias.The results of the PRISMA statement showed that the included system evaluation reports were relatively complete.The present evidence showed that prophylactic use of antimicrobials may be beneficial and recommended in women withⅢ-Ⅳperineal fissures,with no significant benefit in women with manual placenta removal,but prophylactic use of antimicrobials was recommended considering their invasive nature,but it was controversial whether antimicrobials should be used in the categories of vaginal assisted delivery,perineal lateralization,and spontaneous delivery(without complications).Conclusion Antimicrobial prophylaxis may not be recommended for all the pregnant women undergoing vaginal delivery to prevent the postpartum infection,but considering the low methodological quality of the included systematic review and the inconsistent outcomes in this field,the conclusion should be further verified by future research with high-quality.

关 键 词：经阴道分娩 抗菌药物预防 系统评价再评价 结局指标条目池 核心指标集 

分 类 号：R714.62[医药卫生—妇产科学]