剖宫产术中不同时机行血管介入阻断对凶险性前置胎盘患者及胎儿影响的Meta分析  

Influence of vascular interventional occlusion at different time points during cesarean section on patients with pernicious placenta previa and their fetuses:a meta-analysis

作　　者：黄笛 黄智勇[1] 阮强[1] 黄强[1] 郭伟昌[1] 李昭辉 HUANG Di;HUANG Zhi-yong;RUAN Qiang;HUANG Qiang;GUO Wei-chang;LI Zhao-hui(Department of Vascular Surgery,Yibin First People's Hospital,Yibin 644000,Sichuan,CHINA;Yibin Center for Disease Control and Prevention,Yibin 644600,Sichuan,CHINA)

机构地区：[1]宜宾市第一人民医院血管外科,四川宜宾644000 [2]宜宾市疾病预防控制中心,四川宜宾644600

出　　处：《海南医学》2024年第20期2998-3005,共8页Hainan Medical Journal

基　　金：四川省宜宾市宜宾学院医学研究基金(编号:2024YBUYXJJ017)。

摘　　要：目的系统评价剖宫产术中不同时机行血管介入阻断对凶险性前置胎盘患者及胎儿的影响。方法采用计算机检索PubMed、Embase、Medline、Web of Science、维普、万方数据库、中国知网、中国生物医学文献数据库等中不同时机行血管介入阻断对凶险性前置胎盘的相关研究。检索时限为建库至2024年3月1日,由两名研究员独立筛选随机对照或回顾性文献、提取数据,选用Review Manager 5.4.1软件分析,参照Cochrane协作网提供的偏倚风险评估工具对文献质量进行评估。结果共纳入12篇目标文献,1030例凶险性前置胎盘患者。Meta分析结果显示,胎儿娩出前阻断可降低术后子宫切除率(OR=0.54,95%CI:0.33~0.89)和术后入住ICU病房率(OR=0.34,95%CI:0.19~0.63),但不能降低序贯子宫动脉栓塞率(OR=0.61,95%CI:0.28~1.32)。此外,对胎儿1 min Apgar评分(MD=0.11,95%CI:-0.23~0.46)、5 min Apgar评分(MD=0.10,95%CI:-0.04~0.24)、1 min Apgar评分≤7分(OR=0.81,95%CI:0.36~1.85)、5 min Apgar评分≤7分(OR=0.93,95%CI:0.33~2.63)无明显影响。结论胎儿娩出前介入阻断的临床价值更高,且不会增加胎儿不良结局。Objective To systematically evaluate the influence of vascular interventional occlusion at different time points during cesarean section on patients with pernicious placenta previa and their fetuses.Methods PubMed,Embase,Medline,Web of Science,VIP,Wanfang Data,CNKI,China Biomedical Literature Database were were searched systematically from inception to March 1,2024 for relevant studies on pernicious placenta previa treated with vascular interventional occlusion at different time points.Two reviewers independently screened the randomized controlled trial or retrospective study literature and extracted the data.Review Manager 5.4.1 software was used for analysis,and the quality of the literature was evaluated with reference to the risk of bias assessment tool provided by the Cochrane Collaboration.Results A total of 12 studies were included,with a total of 1030 patients with pernicious placenta previa.The results of meta-analysis showed that pre-delivery occlusion could decrease the rate of hysterectomy(OR=0.54,95%CI:0.33-0.89)and ICU admission(OR=0.34,95%CI:0.19-0.63),but it could not reduce the rate of sequential uterine artery embolization(OR=0.61,95%CI:0.28-1.32).Besides,it did not influence the fetus'1-minute Apgar score(MD=0.11,95%CI:-0.23 to 0.46),5-minute Apgar score(MD=0.10,95%CI:-0.04 to 0.24),rate of 1-minute Apgar score≤7(OR=0.81,95%CI:0.36-1.85),and rate of 5-minute Apgar score≤7(OR=0.93,95%CI:0.33-2.63).Conclusion Pre-delivery interventional occlusion has higher clinical value and does not increase adverse outcomes for fetus.

关 键 词：剖宫产 时机 血管介入 前置胎盘 META分析 

分 类 号：R719.8[医药卫生—妇产科学]