初产妇阴道分娩会阴切开危险因素的Meta分析  

Meta-analysis of risk factors for episiotomy in vaginal delivery in primiparas

作　　者：朱立强 王冬梅 李新丽 王兴存 张广峰 杨海青 ZHU Liqiang;WANG Dongmei;LI Xinli;WANG Xingcun;ZHANG Guangfeng;YANG Haiqing(Department of Quality Management,the Central Theater Command Air Force Hospital of People's Liberation Army,Datong 037006,China;Department of Gynecology and Obstetrics,the Central Theater Command Air Force Hospital of People's Liberation Army,Datong 037006,China)

机构地区：[1]中部战区空军医院质量管理科,大同市037006 [2]中部战区空军医院妇产科,大同市037006

出　　处：《护理管理杂志》2024年第1期66-72,共7页Journal of Nursing Administration

摘　　要：目的分析初产妇阴道分娩会阴切开的危险因素。方法检索Cochrane Library、PubMed、Embase、Web of Science、中国生物医学文献数据库、中国知网、万方医学网、维普中文科技期刊数据库,收集建库至2023年7月20日关于初产妇会阴切开危险因素的队列研究、病例对照研究或横断面调查。研究者根据规范要求筛选相关文献、提取所需数据并对文献质量进行评价,采用RevMan 5.4.1软件进行定量Meta分析。结果共纳入16篇文献,初产妇48513例,会阴切开22818例,会阴切开率为47.03%,共18项危险因素,其中产妇5项、胎儿7项、医学干预措施5项、医务人员1项。Meta分析显示,初产妇会阴切开的危险因素包含:产妇因素为第二产程时长>1 h[OR=2.88,95%CI(2.50,3.32),P<0.001]、第二产程时长>3 h[OR=2.04,95%CI(1.69,2.46),P<0.001]和会阴水肿[OR=5.65,95%CI(3.87,8.24),P<0.001];胎儿因素为羊水粪染[OR=1.88,95%CI(1.56,2.27),P<0.001]、宫内窘迫[OR=6.38,95%CI(4.72,8.63),P<0.001]、胎儿体重≥3500 g[OR=1.67,95%CI(1.28,2.18),P<0.001]和巨大儿[OR=1.53,95%CI(1.31,1.79),P<0.001];医学干预措施因素为麻醉镇痛[OR=1.20,95%CI(1.13,1.26),P<0.001]、产钳助产[OR=13.11,95%CI(3.07,55.93),P<0.001]、引产[OR=1.22,95%CI(1.10,1.35),P<0.001]和胎头吸引术[OR=18.62,95%CI(8.00,43.34),P<0.001],其余因素不影响初产妇是否进行会阴切开。结论本研究确定的影响初产妇会阴切开的多种危险因素可作为预测工具促进未来临床实践共识的形成,降低基于不合理因素的会阴切开的不良预后。Objective To analyze the risk factors for episiotomy in vaginal delivery in primiparas.Methods Cochrane Library,PubMed,Embase,Web of Science,CBM,CNKI,Wanfang Medical Network,VIP Chinese Technology Periodical Database were searched.Cohort studies,case-control studies or cross-sectional surveys on the risk factors for episiotomy in primiparas were collected from the database establishment to July 20,2023.Researcher screened the relevant literature,extracted the required data and evaluated the quality of the literature according to the specifications.RevMan 5.4.1 software was used for quantitative Meta-analysis.Results A total of 16 literatures were included,including 48513 primiparas,22818 cases of episiotomy,the episiotomy rate was 47.03%.A total of 18 risk factors were identified,including 5 maternal risk factors,7 fetal risk factors,5 medical interventions,and 1 medical staff risk factors.Meta-analysis showed that the risk factors for primigravid in primiparas included the following:maternal risk factors were prolongation of the second stage of labor>1 h[OR=2.88,95%CI(2.50,3.32),P<0.001],prolongation of the second stage of labor>3 h[OR=2.04,95%CI(1.69,2.46),P<0.001]and perineal edema[OR=5.65,95%CI(3.87,8.24),P<0.001],neonatal factors were meconium stained amniotic fluid[OR=1.88,95%CI(1.56,2.27),P<0.001],fetal distress[OR=6.38,95%CI(4.72,8.63),P<0.001],fetal weight≥3500 g[OR=1.67,95%CI(1.28,2.18),P<0.001]and macrosomia[OR=1.53,95%CI(1.31,1.79),P<0.001],medical intervention measures were anesthesia analgesia[OR=1.20,95%CI(1.13,1.26),P<0.001],forceps delivery[OR=13.11,95%CI(3.07,55.93),P<0.001],induction of labor[OR=1.22,95%CI(1.10,1.35),P<0.001],and fetal head extraction[OR=18.62,95%CI(8.00,43.34),P<0.001],and the rest of the factors did not influence whether or not the primigravida underwent episiotomy.Conclusion The multiple risk factors identified in the study can be used as predictive tools to promote the formation of future clinical practice consensus and reduce the poor prognosis of episiotomy based on unr

关 键 词：初产妇 阴道分娩 会阴切开 危险因素 META分析 

分 类 号：R473.71[医药卫生—护理学]