卡前列素氨丁三醇辅助预防前置胎盘剖宫产术中术后出血疗效与安全性的系统评价

Efficacy and Safety of Romethamine for Assisted Prevention of Intraoperative and Postoperative Hemorrhage in Placenta Previa Puerpera during Caesarean Section:a Systematic Review

目的:系统评价卡前列素氨丁三醇辅助预防前置胎盘剖宫产术中术后出血的疗效与安全性,为临床提供循证参考。方法:计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库和Pub Med,收集卡前列素氨丁三醇(试验组)对比常规治疗或常规治疗联用米索前列醇(对照组)辅助预防前置胎盘剖宫产术中术后出血的随机对照试验(RCT),提取资料并按Cochrane系统评价员手册5.2.0评价质量后,采用Rev Man 5.2统计软件进行Meta分析。结果:最终纳入18项RCT,包括1 824例患者。Meta分析结果显示,试验组产妇剖宫产术中出血量[MD=-138.16,95%CI(-162.97,-113.35),P<0.001]、术后2 h出血量[MD=-134.33,95%CI(-149.87,-118.79),P<0.001]、术后24 h出血量[MD=-150.78,95%CI(-171.20,-130.37),P<0.001]和术后出血发生率[OR=0.22,95%CI(0.10,0.47),P<0.001]显著低于对照组,差异均有统计学意义;试验组产妇不良反应发生率显著低于对照组[OR=2.37,95%CI(1.09,5.17),P=0.03],差异有统计学意义。结论:卡前列素氨丁三醇可辅助降低前置胎盘剖宫产术中及术后出血量,且不增加不良反应的发生。

OBJECTIVE:To evaluate therapeutic efficacy and safety of romethamine for assisted prevention of intraoperative and postoperative hemorrhage in placenta previa puerperal during caesarean section,and to provide evidence-based reference in clinic.METHODS:Retrieved from CNKI,Wanfang database,VIP,CBM and PubMed,randomized controlled trials(RCT)about romethamine(trial group)vs.routine therapy alone,or routine therapy combined(with)misoprostol(control group)for assisted prevention of intraoperative and postoperative hemorrhage in placenta previa puerperal during caesarean section were collected.Meta-analysis was conducted by using Rev Man 5.2 statistical software after data extraction and quality evaluation with Cochrane system evaluator manual 5.2.0.RESULTS:A total of 18 RCTs were included finally,involving 1 824 patients.Results of Meta-analysis showed that intraoperative bleeding amount[MD=-138.16,95%CI(-162.97,-113.35),P<0.001],bleeding amount 2 h after surgery[MD=-134.33,95%CI(-149.87,-118.79),P<0.001],bleeding amount 24 h after surgery[MD=-150.78,95%CI(-171.20,-130.37),P<0.001]and the incidence of postoperative hemorrhage[OR=0.22,95%CI(0.10,0.47),P<0.001]in trial group were significantly lower than control group,with statistical significance.The incidence of ADR in trial group was significantly lower than control group[OR=2.37,95%CI(1.09,5.17),P=0.03],with statistical significance.CONCLUSIONS:Romethamine can reduce intraoperative and postoperative bleeding amount in placenta previa puerperal during caesarean section,and do not increase the occurrence of ADR.