经皮神经电刺激减轻阴道试产妇女分娩疼痛的meta分析  

Meta-analysis on transcutaneous electrical nerve stimulation(TENS)for pain relief among women undergoing vaginal trial of labor

作　　者：顾怡云 徐方萍 李志珍 张国英 顾春怡[1] GU Yi Yun;XU Fang Ping;LI Zhi Zhen;ZHANG Guo Ying;GU Chun Yi(Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;School of Nursing,Fudan University,Shanghai 200032,China;Dongying People's Hospital,Dongying 257091,Shandong Province,China)

机构地区：[1]复旦大学附属妇产科医院,上海200011 [2]复旦大学护理学院,上海200032 [3]东营市人民医院,山东东营257091

出　　处：《中国妇幼卫生杂志》2024年第6期63-72,共10页Chinese Journal of Women and Children Health

基　　金：国家自然科学基金资助项目(72004029);上海市护理学会科研课题(2023QN-B06);复旦大学复星护理科研基金项目(FNF202252)。

摘　　要：目的 系统评价经皮神经电刺激(Transcutaneous Electrical Nerve Stimulation,TENS)对阴道试产妇女分娩疼痛的影响。方法 检索PubMed、Embase、CINAHL、Cochrane Library、Web of Science、JBI、中国知网、万方、维普和中国生物医学文献服务系统等数据库,搜集TENS对阴道试产妇女分娩疼痛影响的随机对照试验相关文献,检索时限均为建库至2024年1月2日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行meta分析。结果 共纳入32项研究,包括4 584例产妇。Meta分析结果显示,TENS组的视觉疼痛模拟评分(Visual Analogue Scale,VAS)评分低于对照组(MD=–0.82, 95%CI:-1.07~-0.58, P <0.001),产程时长(SMD=-0.50,95%CI:-0.64~-0.36,P <0.001)、产时剖宫产率(RR=0.51, 95%CI:0.40~0.66,P <0.001)也低于对照组,而两组在阴道助产率(RR=1.3,95%CI:0.80~2.11, P=0.30)和新生儿出生1 min时Apgar评分(MD=-0.01,95%CI:-0.07~0.05, P=0.65)的差异无统计学意义。结论 TENS能够减轻阴道试产妇女第一产程阶段的分娩疼痛程度,缩短产程时长,降低产时剖宫产率。然而受限于纳入研究的质量,该结论存在较高的偏倚风险,未来有必要开展高质量随机对照试验研究以验证上述结论,并且需统一TENS技术方案的具体实施标准。Objective To systematically evaluate the effect of transcutaneous electrical nerve stimulation(TENS)on labor pain among women undergoing vaginal trial of labor.Methods Databases including PubMed,Embase,CINAHL,Cochrane Library,Web of Science,JB,CNKI,Wanfang,VIP and SinoMed were searched for randomized controlled trials on TENS for labor pain relief from the inception to January 2nd,2024.Two reviewers screened studies,extracted data,and assessed risk of bias independently.Meta-analysis was conducted through RevMan 5.4.Results A total of 32 studies with 4584 subjects were recruited.Met-analysis showed that TENS reduced Visual Analogue Scale(VAS)pain scores(MD=-0.82,95%CI:-1.07~-0.58,P<0.001),labor duration(SMD=-0.50,95%CI:-0.64~-0.36,P<0.001)and cesarean section rate(RR=0.51,95%CI:0.40~0.66,P<0.001)compared to control group.While no significant differences were found in instrumental delivery rates(RR=1.3,95%CI:0.80~2.11,P=0.30)and 1-minute Apgar scores(MD=-0.02,95%CI:-0.09~0.06,P=0.14)between the two groups.Conclusion TENS can reduce labor pain in the first stage of labour,shorten labor process,and decrease intrapartum cesarean rate.But the result of this study may be biased limited by the quality of these researches.Further high-quality randomized controlled trials are needed to confirm these findings and standardize TENS implementation techniques.

关 键 词：经皮神经电刺激 孕产妇 分娩疼痛 系统评价 META分析 

分 类 号：R714.3[医药卫生—妇产科学]