剖宫产术前和断脐后预防性应用头孢唑啉的效果比较:随机对照试验的系统回顾和Meta分析

Comparison on effect of prophylactic administration of cefazolin prior to cesarean section and after cord clamping:a systematic review and Meta analysis of randomized controlled trials

目的:总结已发表的文献,分析比较剖宫产术前和断脐后应用头孢唑啉的效果。方法:通过系统性搜索数据库,包括PubMed、Embase和Cochrane图书馆的CENTRAL,进行随机对照试验,比较剖宫产术前预防性应用头孢唑啉与断脐后应用的差异。结果:对6个高质量的随机对照试验进行Meta分析。术前预防性应用头孢唑啉与断脐后应用相比较,产后子宫内膜炎的发病风险有明显的降低(RR=0.57,95%CI=0.36～0.90,P=0.02)。而伤口感染(RR=0.70,95%CI=0.43～1.12)和尿路感染发病风险(RR=1.19,95%CI=0.53～2.63)无明显差别。而且,术前应用头孢唑啉并没有明显增加新生儿败血症(RR=0.82,95%CI=0.47～1.42)、需要诊断检查而未确诊的败血症(RR=0.94,95%CI=0.72～1.22)以及新生儿转入重症监护室(RR=0.90,95%CI=0.62～1.28)的风险。结论:剖宫产术前预防性应用头孢唑啉可明显降低产后子宫内膜炎的发病率。

Objective：To summarize the published evidences and to compare effect of prophylactic administration of cefazolin prior to cesarean section and after cord clamping. Methods：Databases of PubMed, Embase, and CENTRAL in the Cochrane Library were searched for randomized controlled trials and effect of prophylactic administration of cefazolin prior to cesarean section and after cord clamping were compared. Results：Six randomized controlled trials with high quality were included in this Meta analysis. Preoperative administration significantly reduced the risk of postpartum endometritis（RR=0.57,95%CI=0.36 to 0.90,P=0.02）. Preoperative admin- istration of cefazolin was not associated with significant reduction in the risk of wound infection（RR=0.70,95%Cl=0.43 to 1.12） and urinary tract infection （RR = 1.19,95% CI=0.53 to 2.63）. Furthermore, preoperative administration of cefazolin did not significantly af- fect proven neonatal sepsis （RR =0.82,95%CI=0.47 to 1.42）, suspected neonatal sepsis cases which require workup （RR =0.94,95% CI=0.72 to 1.22） and neonatal intensive care unit admissions（RR=0.90,95%Cl=0.62 to 1.28）. Conclusion：Prophylactic administra- tion of cefazolin prior to cesarean section can significantly decrease the incidence of postpartum endometritis.