硫酸镁预防剖宫产术产妇寒战的meta分析

Meta-analysis of Magnesium Sulfate to prevent shivering during cesarean section

目的评估硫酸镁预防剖宫产术产妇寒战的临床应用效果。方法计算机检索PubMed、The Cochrane Library(2019年第8期)、EMbase、万方数据知识服务平台(WanFang Data)、中国知网(CNKI)、中国生物医学文献数据库(CBM),查找有关硫酸镁对实施剖宫产术的产妇寒战影响的随机对照试验(RCT),检索时限为建库—2019年8月。根据所纳入RCT参考文献的相关文献进行追溯。采用RevMan 5.3软件进行meta分析,GRADE证据质量评价评估meta分析结果的证据等级。结果最终纳入15篇文献,1043例患者,使用硫酸镁患者532例。meta分析结果显示:试验组产妇寒战发生率低于对照组(RR=0.48,95%CI:0.37~0.63,P<0.00001)。静脉注射亚组产妇寒战发生率低于对照组(RR=0.46,95%CI:0.33~0.66,P<0.0001);蛛网膜下腔注射亚组产妇寒战发生率与对照组比较,差异无统计学意义(P=0.12);硬膜外注射亚组产妇寒战发生率低于对照组(RR=0.38,95%CI:0.21~0.67,P=0.0009)。蛛网膜下腔麻醉亚组产妇寒战发生率低于对照组(RR=0.53,95%CI:0.36~0.78,P=0.001);腰硬联合麻醉亚组产妇寒战发生率低于对照组(RR=0.45,95%CI:0.29~0.68,P=0.0002)。不同给药方式亚组meta分析结果质量等级均为“Moderate”。结论静脉注射、硬膜外注射硫酸镁能够预防行剖宫产术产妇寒战的发生,但蛛网膜下腔注射硫酸镁预防行剖宫产术产妇寒战的效果尚待评估。

Objective To evaluate the effect of Magnesium Sulfate to prevent shivering during cesarean section.Methods Databases including PubMed,The Cochrane Library(Issue 8,2019),EMbase,Wanfang Data Knowledge Service Platform(WanFang Data),China National Knowledge Infrastructure(CNKI),China Biology Medicine disc(CBM)were searched for computer to collect the randomized controlled trails(RCT)about the effect of Magnesium Sulfate on shivering for cesarean section.The retrieval time limit from repository to August 2019.The literature was tracked based on the references included in the RCT.Meta-analysis was conducted using RevMan 5.3 software,GRADE of evidence quality was used to evaluate the evidence level of meta-analysis results.Results Finally,15 references were included,including 1043 patients and 532 patients with Magnesium Sulfate.The results of meta-analysis showed that:the incidence of shivering in experimental group was lower than that in control group(RR=0.48,95%CI:0.37-0.63,P<0.00001).The incidence of shivering in intravenous subgroup was lower than that in control group(RR=0.46,95%CI:0.33-0.66,P<0.0001);the incidence of shivering in subarachnoid injection subgroup had no statistically significant difference compared with control group(P=0.12);the incidence of shivering in epidural injection subgroup was lower than that in control group(RR=0.38,95%CI:0.21-0.67,P=0.0009).The incidence of shivering in subarachnoid anesthesia subgroup was lower than that in control group(RR=0.53,95%CI:0.36-0.78,P=0.001);the incidence of shivering in combined lumbar and epidural anesthesia subgroup was lower than that in control group(RR=0.45,95%CI:0.29-0.68,P=0.0002).Meta-analysis results for different administration subgroups were all evaluated as“Moderate”.Conclusion Intravenous injection and epidural injection of Magnesium Sulfate can prevent shivering in cesarean section,but the effect of subarachnoid injection of Magnesium Sulfate to prevent the occurrence of shivering in cesarean section remains to be evaluated.