卡贝缩宫素预防剖宫产产后出血的快速卫生技术评估

Carbetocin for preventing postpartum haemorrhage of cesarean section:a rapid health technology assessment

目的:基于快速卫生技术评估(health technology assessment,HTA)方法,评价卡贝缩宫素注射液预防剖宫产产后出血的有效性、安全性和经济性,相对高效、快捷地为临床合理用药和医疗机构药物遴选提供一定的参考。方法:系统检索PubMed、Cochrane library等英文数据库和中国知网(CNKI)、万方数据等中文数据库。由2位评价者根据纳入与排除标准独立筛选文献、提取资料和评价质量后,对结果进行定性分析。结果:共纳入6篇Meta分析和5篇经济学研究。在剖宫产患者中,与缩宫素相比,卡贝缩宫素可显著降低产后出血率、出血量、需要治疗用宫缩剂的患者比例和需要其他促宫缩措施的患者比例;在择期剖宫产患者中,卡贝缩宫素不能降低产后出血率,但是能减少需要治疗用宫缩剂和其他促宫缩措施的患者比例。卡贝缩宫素组的不良反应发生率更低。国外的经济学研究表明,卡贝缩宫素具有明显的成本效果优势。结论:卡贝缩宫素预防剖宫产后出血具有良好的有效性和安全性,在我国应用是否具有经济性需进一步研究。

Objective:This study was designed to evaluate the effectiveness,safety and economy of carbetocin in preventing postpartum hemorrhage of cesarean section using a rapid health technology assessment(HTA).Methods:Systematic review,meta-analysis,HTA and research of pharmacoeconomics were searched in the PubMed,Cochrane library,CNKI,Wanfang data.Two reviewers independently identified studies,extracted data and assessed the quality of included studies.Qualitative analysis was performed.Results:6 systematic reviews and 5 pharmacoeconomic studies were included.In the cesarean section,compared with oxytocin,use of carbetocin could significantly reduce postpartum bleeding rate,blood loss,the proportion of additional uterotonic agents and uterine massage.In elective cesarean section,carbetocin could not reduce postpartum hemorrhage,but it could reduce the need for additional uterotonic agents and uterine massage.Furthermore,the incidence of adverse reactions was lower in the carbetocin group.Pharmacoeconomic studies abroad had shown that carbetocin was cost effective as prophylaxis against postpartum hemorrhage in cesarean section.Conclusion:Carbetocin is effective and safe in preventing hemorrhage after cesarean section.Whether it is economical to use in our country still needs to be studied.