硬膜外镇痛不同给药方式对分娩结局影响的网状Meta分析

Labor analgesia methods to improve labor outcome:a network meta⁃analysis

目的应用网状Meta分析评价持续硬膜外镇痛(continuous epidural infusion,CEI)、自控硬膜外镇痛(patient⁃controlled epidural analgesia,PCEA)、硬膜外间歇脉冲式给药(Programmed intermittent epidural bolus,PIEB)、CEI+PCEA和PIEB+PCEA等5种硬膜外分娩镇痛给药方法对分娩结局的影响。方法检索PubMed、EMbase、Web of Science等数据库,检索时间截止2020年2月3日。统计分析数据用ADDIS 1.16.8软件。结果共纳入34篇RCTs,网状Meta分析结果显示:(1)对于器械助产率、VAS评分、低血压和寒颤发生率、新生儿1 min及5 min Apgar评分等,5种给药技术之间差异无统计学意义;(2)对于剖宫产率,CEI比CEI+PCEA、PIEB、PIEB+PCEA均高;(3)对于第二产程,CEI+PCEA比PCEA长;(4)对于运动阻滞发生率,CEI比PCEA、PIEB+PCEA高,PIEB+PCEA比CEI+PCEA、PCEA、PIEB低。结论本研究结果表明5种硬膜外镇痛给药技术都是安全有效的;CEI可能是最不推荐的,PIEB+PCEA可能是最佳。

Objective The aim of this study is to complete a network meta⁃analysis to clarify the best epidural analgesia methods among five popular methods(CEI,PCEA,PIEB,CEI+PCEA,PIEB+PCEA).Methods This network meta⁃analysis was conducted using the PubMed,EMBASE,Web of Science with the aim of identifying those randomized controlled trials(RCTs)that performed a comparison among five epidural analgesia methods in healthy primiparas.We searched from inception to 3 February 2020.The data were analyzed using ADDIS 1.16.8.Results 34 eligible trials were included,the results of network meta⁃analysis showed that there was no significant difference among the five administration techniques for the incidence of instrumental delivery,VAS score,the risk of hypotension and shivering,and newborns′Apgar score.For the incidence of cesarean section,CEI+PCEA,PIEB,PIEB+PCEA were outweighed CEI.For the duration of 2nd stage,PCEA was shorter than CEI+PCEA;4.PCEA,PIEB+PCEA had less motor block than CEI,PIEB+PCEA had less motor block than CEI+PCEA,PCEA,PIEB.Conclusions The results of the present study suggest that the 5 epidural analgesia methods are safe and effective.On the basis of current evidence,we considered that CEI may be the least,PIEB+PCEA may be the best.