产程时限变化的荟萃分析

Change of labor duration ： a systematic analysis

目的系统评价自然临产健康单胎头位初产妇的产程时限变化。方法检索1990年1月至2011年8月，PubMed数据库、EMBase数据库、Cochrane图书馆数据库中以laborduration、nulliparous、spontaneousvertexdelivery、friedmanlaborcurve为主题词；以及中国知网（CNKI）、维普数据库（VIP）、万方医学网中以产程、产程图、头位、初产妇为主题词，选出对健康单胎头位初产妇产程研究的文章，并与70年前的Friedman产程曲线比较，对纳入的研究应用RevMan5．1软件进行荟萃分析。结果1990年1月至2011年8月最终有11篇文献纳入本研究，共4534例健康单胎头位初产妇。荟萃分析结果显示，近20年健康单胎头位初产妇第一产程活跃期时限比Friedman产程曲线平均延长1．61h，两者比较，差异有统计学意义[P=0．01，加权均数差值（WMD）=1．61，95％C／为0．38—2．83]；第二产程时限比Friedman产程曲线平均缩短12min，两者比较，差异也有统计学意义（P=0．0006，WMD=-0．20，95％C／为-0．31--0．09）。结论近20年来健康单胎头位初产妇第一产程活跃期及第二产程较Friedman产程曲线明显改变，重新评定正常产程时限标准，对指导产程处理，减少不必要的干预有重要意义。

Objective To evaluate the compared with Friedman labor curve. Methods labor duration of healthy primiparas in the past 20 years Published observational studies about labor duration in primiparas with singleton vertex presentation were searched in PubMed, EMBase, Cochrane library, CNKI, VIP and Wanfang database. The Cochrane Collaboration＇ s RevMan 5.1 software was used for meta- analysis. Results Eleven literatures involving 4534 primiparas were included, which were eligible for the criteria to investigate the labor duration. Meta-analysis showed that the length of active phase was significantly different between what was showed in primiparas in the past 20 years and Friedman labor curve [ P = 0. 01, weighted mean difference （WMD） = 1.61,95% CI： O. 38 to 2. 83 ] , and significant differences were also found in the second stage duration （ P = O. 0006, WMD = - 0. 20,95 % CI： - 0. 31 to - O. 09）. Conclusions Compared with Friedman labor curve, active phase length of healthy primiparas in the past 20 years was significantly longer and second stage length was shorter. Reassessing labor curve of healthy primiparas is required for more scientific guidance and less unnecessary interventions.