卡贝缩宫素对比缩宫素预防剖宫产后出血有效性及安全性的Meta-分析

Meta-analysis of effectiveness and safety of caebetocin vs oxytocin in prevention of postpartum hemorrhage of cesarean section

目的系统评价卡贝缩宫素对比缩宫素预防产后出血的临床疗效和安全性。方法计算机检索EMbase、Pub Med、中国期刊全文数据库(CNKI)、维普中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)和万方数据库,收集卡贝缩宫素对比缩宫素用于预防产后出血的随机对照研究(RCT),检索时限均从2000年1月至2017年12月。由2位研究者筛选文献、提取资料,采用Rev Man 5.1软件进行Meta-分析。结果共纳入14个RCTs,3 052例患者。Meta-分析结果显示相对于缩宫素,卡贝缩宫素能显著降低产后出血率[OR=0.48,95%CI(0.36~0.63),P<0.001],术中出血量[MD=-67.31,95%CI(-86.34^-48.28),P<0.001]、术后2 h出血量[MD=-50.43,95%CI(-71.32^-29.55),P<0.001]和术后24 h出血量[MD=-62.87,95%CI(-85.59^-40.16),P<0.001];血红蛋白减少[MD=-4.24,95%CI(-6.16^-2.31),P<0.001]和不良反应发生率[OR=0.52,95%CI(0.41~0.65),P<0.001]。结论本研究结果显示卡贝缩宫素预防产后出血的临床疗效和安全性优于缩宫素,值得临床推广。

Objective To evaluate the effectiveness and safety of caebetocin vs oxytocin in prevention of postpartum hemorrhage of cesarean section. Methods The related literatures were searched in the following databases： Pub Med, EMbase, CNKI, VIP, and Wan Fang Data from January 2000 to December 2017. Randomized controlled trial（RCT） of caebetocin vs oxytocin in prevention of postpartum hemorrhage of cesarean section was included. Two reviewers independently screened literatures and extracted data. Meta-analysis was conducted by Rev Man 5.1 software. Results A total of 14 RCTs were collected, including 3 052 patients. The Meta-analysis showed that： compared with oxytocin, caebetocin could significantly reduce the rate of postpartum hemorrhage [OR=0.48, 95%CI（0.36-0.63）, P〈0.001]; intraoperative bleeding [MD=-67.31, 95%CI（-86.34--48.28）, P〈0.001], postoperative 2 h bleeding [MD=-50.43, 95%CI（-71.32--29.55）, P〈0.001], and postoperative 24 h bleeding [MD=-62.87, 95%CI（-85.59--40.16）, P〈0.001]; hemoglobin reduction [MD=-4.24, 95%CI（-6.16--2.31）, P〈0.001] and incidence of adverse reactions [OR=0.52,95%CI（0.41 - 0.65）, P〈0.001]. Conclusion The results of this study showed that the clinical efficacy and safety of caebetocin is better than oxytocin in prevention of postpartum hemorrhage, and it is worthy of clinical use.