坐位与侧卧位在剖宫产重比重布比卡因腰麻中有效性和安全性的Meta分析

A Meta-analysis comparing the effectiveness and safety of lumbar anesthesia for cesarean delivery using hyperbaric bupivacaine in the sitting position versus the lateral recumbent position

目的 使用Meta分析比较坐位与侧卧位两种穿刺体位下采用重比重布比卡因应用于剖宫产术腰麻的有效性和安全性。方法 计算机检索PubMed、The Cochrane Library、EMbase、VIP、CNKI、CBM和WanFang Data等数据库,查找关于坐位和侧卧位下实施重比重腰麻用于剖宫产术的随机对照研究(RCT),检索时限从建库至2021年8月,按照纳入和排除标准筛选文献,提取资料和评价质量后采用RevMan 5.3软件进行Meta分析。结果 本研究纳入11个RCT,共581例患者,坐位组295例,侧卧位组286例。Meta分析结果显示:坐位组腰麻到达感觉阻滞平面T5的时间长于侧卧位组[WMD=2.8,95%CI(0.64-3.63),P=0.005]。两组运动阻滞的程度、到达最高运动阻滞程度的时间、从腰麻到手术开始切皮的时间、低血压发生率、呕吐发生率差异均无统计学意义,但侧卧位组的恶心发生率更高[RR=0.59,95%CI(0.39-0.87),P=0.009]。结论 采用重比重布比卡因,坐位组比侧卧位组腰麻到达手术有效阻滞的时间更长,但不影响手术开始时间,坐位组母体恶心的发生率更低,母体舒适度更好。由于偏倚风险不确定,以上结论尚待更多高质量研究加以验证。

Objective Meta-analysis was used to compare the effectiveness and safety of lumbar anesthesia for cesarean section using hyperbaric bupivacaine in seated and lateral positions.Methods PubMed, The Cochrane Library, EMbase, VIP,CNKI,CBM,and WanFang Data were searched for randomized controlled trials(RCT) of hyperbaric spinal anesthesia in sitting versus lateral decubitus for cesarean section from inception to August 2021.Literatures were screened according to the inclusion and exclusion criteria, and RevMan 5.3 software was used for Meta-analysis after data extraction and quality evaluation.Results This study included 11 RCTs with a total of 581 patients, 295 in the sitting group and 286 in the lateral recumbent group.Meta analysis showed that the time to reach the sensory block plane T5for lumbar anesthesia in the sitting group was longer than the lateral recumbent group(WMD=2.8,95% CI:0.64-3.63,P=0.005).There were no statistical differences in the degree of motor block, time to reach the highest degree of motor block, time from lumbar anesthesia to the start of surgical skin incision, incidence of hypotension and incidence of vomiting between the two groups, but the incidence of nausea was higher in the lateral recumbent group(RR=0.59,95% CI:0.39-0.87,P=0.009).Conclusion When hyperbaric bupivacaine was used, the sitting group took longer time to reach effective surgical block than the lateral recumbent group for lumbar anesthesia without affecting the start time of the procedure, and the sitting group had a lower incidence of maternal nausea and better maternal comfort.Because of the uncertain risk of bias, the above findings have yet to be validated by additional high-quality studies.