等比重罗哌卡因与重比重罗哌卡因对剖宫产术影响的meta分析

Meta analysis on the effects of equal specific gravity ropivacaine and heavy specific gravity ropivacaine on cesarean section

目的系统评价等比重或重比重罗哌卡因用于产妇剖宫产术的影响。方法计算机检索中国知网、万方、维普、PubMed、Embase、Cochrane Library、中国生物医学文献数据库(CBM)7个数据库,搜索时间自建库至2021年11月30日,检索不同比重罗哌卡因用于剖宫产术的随机对照试验,根据罗哌卡因比重不同分组,观察组为加入脑脊液或生理盐水的等比重罗哌卡因,对照组为加入葡萄糖的重比重罗哌卡因,按照Cochrane偏倚风险评估标准,由两名评价员独立对纳入研究的方法学质量进行评价,并采用RevMan 5.3软件进行meta分析。结果纳入7篇符合标准的文献,涉及726例患者。meta分析结果显示,观察组感觉阻滞起效时间长于对照组[MD=0.40,95%CI(0.11,0.68),P=0.006];观察组感觉阻滞恢复时间短于对照组[MD=-6.49,95%CI(-9.39,-3.59),P<0.0001];观察组的低血压发生率较小[OR=0.35,95%CI(0.23,0.54),P<0.00001];观察组的恶心呕吐发生率较小[OR=0.33,95%CI(0.22,0.51),P<0.00001]。结论等比重罗哌卡因用于剖宫产术麻醉可延长感觉阻滞起效时间,缩短感觉阻滞恢复时间,降低低血压及恶心呕吐的发生率。

Objective To systematically evaluate the effects of equal specific gravity or heavy specific gravity ropivacaine on cesarean section.Methods Seven databases including CNKI,Wanfang,VIP,PubMed,Embase,Cochrane Library and Chinese Biomedical Literature Database(CBM)were searched on computer.The retrieval range spanned from the database establishment to November 30,2021.The randomized controlled trial of ropivacaine with different specific gravity for cesarean section was searched.According to the different specific gravity of ropivacaine,the observation group represented equal specific gravity ropivacaine with cerebrospinal fluid or normal saline added and the control group represented heavy specific gravity ropivacaine with glucose added.According to the Cochrane risk of bias assessment criteria,two evaluators independently evaluated the methodological quality of the included studies,and the RevMan 5.3 software was used for meta analysis.Results Seven pieces of literature meeting the inclusion criteria were included,involving 726 patients.Meta analysis results showed that the onset time of sensory block in the observation group was longer than that in the control group(MD=0.40,95%CI[0.11,0.68],P=0.006).The recovery time of sensory block in the observation group was shorter than that in the control group(MD=-6.49,95%CI[-9.39,-3.59],P<0.0001).The incidence of hypotension in the observation group was lower(OR=0.35,95%CI[0.23,0.54],P<0.00001),and the incidence of nausea and vomiting in the observation group was lower(OR=0.33,95%CI[0.22,0.51],P<0.00001).Conclusion Equal specific gravity ropivacaine for use in cesarean section can prolong the onset time of sensory block,shorten the recovery time of sensory block,and reduce the incidence of hypotension,nausea and vomiting.