系统评价硬膜外分娩镇痛时机对初产妇分娩过程的影响:Meta分析

Systematic review of the effect of epidural analgesia in labor on obstetic outcome of nulliparous women: A Meta Analysis

目的系统评价硬膜外分娩镇痛的时机对初产妇分娩过程的影响。方法利用Cochrane图书馆、Pub Med、Embase、Web of Science、OVID、Science Direct数据库和谷歌学术对关键词"epidural analgesia"、"labor"、"timing"或"early"或"latent"进行联合检索,收集研究硬膜外分娩镇痛时机对产妇分娩过程影响的同期对照的实验性研究。由两位独立研究人员根据纳入与排除标准筛选文献并进行质量评价后,提取文献中的相关资料,包括一般信息和特征信息,利用Review Manager 5.2软件进行Meta分析。结果最终筛选出6篇符合条件的文献,主要对第一产程、第二产程、产钳助产率、剖宫产率、新生儿状况进行评价。分析第一产程时,早期硬膜外镇痛组纳入6 817例产妇,晚期硬膜外镇痛组纳入6 819例产妇,Meta分析结果显示,早期硬膜外镇痛组第一产程与晚期硬膜外镇痛组差异无统计学意义(P>0.05)。分析第二产程时,早期硬膜外镇痛组纳入7 113例产妇,晚期硬膜外镇痛组纳入7 121例产妇,Meta分析结果显示,早期硬膜外镇痛组第二产程短于晚期硬膜外镇痛组(P<0.05)。分析产钳助产率时,早期硬膜外镇痛组纳入7 273例产妇,晚期硬膜外镇痛组纳入7 269例产妇,Meta分析结果显示,两组之间产钳助产率差异无统计学意义(P>0.05)。分析剖宫产率时,早期硬膜外镇痛组纳入7 273例产妇,晚期硬膜外镇痛组纳入7 269例产妇,Meta分析结果显示,两组之间剖宫产率差异无统计学意义(P>0.05)。分析新生儿状况时,早期硬膜外镇痛组纳入7 273例产妇,晚期硬膜外镇痛组纳入7 269例产妇,Meta分析结果显示,两组之间剖宫产率差异无统计学意义(P>0.05)。结论早期启动硬膜外分娩镇痛能够缩短产妇忍受疼痛的时间,而且不会延长产程,不会增加产钳使用率和剖宫产使用率,不会降低新生儿Apgar评分,因此对产妇有利。

Objective To systemically evaluate the timing of labor epidural analgesia（ LEA） for labor. Methods Combined keywords including ＂ epidural analgesia＂, ＂ labor＂, ＂ timing＂, ＂ early＂,and ＂ latent＂ were searched in database of Cochrane Library,Pub Med,Embase,Web of Science,OVID,Science Direct and Google Scholarto collect concurrent controlled trials using LEA for labor. Two reviewers screened literatures referring to studies according to the inclusion and exclusion criteria,and assessed the quality of them. Data of general information and characteristic information were extracted and used to conduct Meta analysis with Review Manager 5. 2 software. Results Six studies were included and items including first labor stage,second labor stage,instrumental delivery rate,and cesarean section rate were analyzed. For analysis of first labor stage,a total of 6817 subjects in early LEA group and 6819 subjects in late LEA group were collected. The Meta analysis showed that there was no significant difference in the duration of first labor stage between early LEA group and late LEA group（ P〈0. 05）. For analysis of second labor stage,a total of 7113 subjects in early LEA group and 7121 subjects in late LEA group were collected. The Meta analysis showed that the duration of second labor stage in early LEA group was shorter than that in late LEA group（ P〉0. 05）. For analysis of instrumental delivery rate,a total of 7273 subjects in early LEA group and 7269 subjects in late LEA group were collected. The Meta analysis showed that there was no difference in instrumental delivery rate between early LEA group and late LEA group（ P〉0. 05）. For analysis of cesarean section rate,a total of 7273 subjects in early LEA group and 7269 subjects in late LEA group were collected. The Meta analysis showed that there was no difference in cesarean section rate between early LEA group and late LEA group（ P〉0. 05）. For analysis of status of newborns,a total of 7273 subjects in early LEA group and 7269 subjects in late LEA group were collected. The Meta analysis showed that there was no difference in status of newborns between early LEA group and late LEA group（ P〉0. 05）. Conclusion Early initiation of LEA can shorten the duration of pain,and it does not delay labor stage,increase the incidence of instrumental vaginal delivery and cesarean section,and decrease newborn＇s Apgar scores,which are advantageous for labor.