椎管内分娩镇痛对剖宫产术后再次妊娠阴道试产母婴结局影响的Meta分析

Effect of intraspinal delivery analgesia on the outcomes of pregnant women and infants undergoing vaginal trial delivery after cesarean section:a Meta-analysis

目的:系统评价椎管内分娩镇痛对剖宫产术后再次妊娠阴道试产母婴结局的影响。方法:计算机检索PubMed、Web of Science、EMbase、the Cochrane Library、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库(WanFang Database)等从建库至2022年4月5日公开发表有关椎管内分娩镇痛和剖宫产术后再次妊娠阴道试产的随机对照研究。由2名研究人员独立按照纳入和排除标准对文献进行选取和筛选,采用RevMan 5.4软件对选取的文献进行统计分析。结果:最终纳入12篇临床研究,均为随机对照试验。Meta分析结果显示,剖宫产术后再次妊娠阴道试产使用椎管内分娩镇痛和常规阴道分娩试产成功率[OR=2.94,95%CI(2.21,3.93),P<0.00001]、使用缩宫素情况[OR=3.42,95%CI(2.01,5.81),P<0.0001]差异有统计学意义;胎儿窘迫发生率[OR=0.70,95%CI(0.42,1.16),P=0.16]、子宫破裂率[OR=0.89,95%CI(0.25,3.13),P=0.86]、产后出血率[OR=1.19,95%CI(0.74,1.90),P=0.47]差异无统计学意义。结论:现有证据表明,剖宫产术后再次妊娠阴道试产使用椎管内分娩镇痛能提高阴道试产率,不会掩盖子宫破裂和胎儿窘迫的发生,不增加产后出血,母婴结局良好。

Objective:To systematically evaluate the effect of intraspinal delivery analgesia on the outcomes of pregnant women and infants undergoing vaginal trial delivery after cesarean section.Methods:PubMed,Web of Science,EMbase,the Cochrane Library,CNKI,CBM,VIP,WanFang base Database and other databases were searched by computer from the inception of the databases to April 5,2022,to find out the randomized controlled studies on intraspinal delivery analgesia and vaginal trial of pregnancy after cesarean section.Two researchers independently selected and screened the literature according to the inclusion and exclusion criteria.RevMan 5.4 software was used for statistical analysis of the selected literature.Results:Finally,12 clinical studies were included,all of which were randomized controlled trials.Meta-analysis results showed that there were statistically significant differences in the success rate[OR=2.94,95%CI(2.21,3.93),P<0.00001]and the use of oxytocin[OR=3.42,95%CI(2.01,5.81),P<0.0001]of vaginal trial labor after cesarean section.There was no significant difference in the incidence of fetal distress[OR=0.70,95%CI(0.42,1.16),P=0.16],uterine rupture rate[OR=0.89,95%CI(0.25,3.13),P=0.86],and postpartum hemorrhage rate[OR=1.19,95%CI(0.74,1.90),P=0.47].Conclusion:Current evidence shows that the use of intraspinal delivery analgesia for vaginal trial delivery after cesarean section can improve the rate of vaginal trial delivery,do not mask the occurrence of uterine rupture and fetal distress,do not increase postpartum bleeding,and have a good maternal and infant outcome.