加温输液对预防产妇剖宫产术后低体温和寒颤有效性的Meta分析

Efficacy of Pre-warmed Intravenous Fluids for Low Temperature and Shivering after Cesarean Section: A Meta-analysis

目的系统评价术中加温输液对预防产妇剖宫产术后低体温和寒颤的影响。方法计算机检索Pub Med、CINAHL、Embase、The Cochrane Library、CBM、VIP、Wan Fang Data和CNKI数据库,搜集术中加温输液对产妇剖宫产手术围术期低体温、寒颤和舒适度影响的随机对照研究,检索时限均为建库至2017年7月。由2名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Rev Man 5.3进行统计分析。结果共纳入20个随机对照研究,包括1 689例患者。Meta分析结果显示:加温组术后核心体温明显高于常温组[MD=0.75,95%CI(0.70,0.80),P<0.00001],加温组术后寒颤的发生率明显低于常温组[RR=0.40,95%CI(0.33,0.48),P<0.00001]。结论现有证据表明,围术期加温输液能降低术后寒颤的发生率,且维持术后较高体温,减少了低体温的发生率。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically review the efficacy of pre-warmed intravenous fluids for low temperature and shivering after cesarean section. Methods We searched Pub Med, CINAHL, EMbase, The Cochrane Library, CBM, VIP, Wan Fang Data and CNKI from the inception to July 2017, to collect randomized controlled trials（RCTs） on efficacy of pre-warmed intravenous fluids for low temperature and shivering after cesarean section. Two reviewers independently screened studies, extracted data and evaluated the risk of biases of included literature. Then meta-analysis was performed using Rev Man 5.3. Results Twenty RCTs involving 1,689 patients were included. The results of meta-analysis showed that the core body temperature in pre-warmed fluids group was obviously higher [MD =0.75, 95% CI（0.70,0.80）, P 0.00001] when compared with that in normal fluids group. The incidence of postoperative shivering in pre-warmed fluids group was obviously lower than that in normal fluids group [ RR=0.40,95%CI（0.33,0.48）,P〈0.00001].Conclusion Perioperative pre-warmed intravenous fluids can decrease the risk of postoperative shivering, and maintain a relatively higher body temperature, and reduce the incidence of hypothermia. Due to the limitations of quality and quantity of included studies,more high quality studies are needed to verify the conclusions.