剖宫产术中不同时机行腹主动脉球囊阻断对凶险性前置胎盘患者临床价值的Meta分析

The clinical value of abdominal aorta balloon occlusion at different times during cesarean section in patients with dangerous placenta previa:A meta-analysis

目的系统评价剖宫产术中不同时机行腹主动脉球囊阻断对凶险性前置胎盘患者的临床价值。方法系统检索PubMed、Embase、Medline、Cochrane Library、Web of Science、中国知网、万方数据、维普、中国生物医学文献数据库等库至2024年3月1日关于不同时机行腹主动脉球囊阻断对凶险性前置胎盘的相关文献,由2名评价者独立筛选文献、提取数据,参照Cochrane协作网提供的偏倚风险评估工具对文献质量进行评估,选用RevMan 5.4.1进行Meta分析。结果共纳入10篇文献,885例凶险性前置胎盘患者。Meta分析结果显示,胎儿娩出前阻断可减少术中出血量[均数差(mean difference,MD)=-296.89,95%置信区间(confidence intervals,CI)=-433.65~-160.13,P<0.001]和输血量(MD=-2.30,95%CI=-3.92~-0.69,P=0.005),降低术后重症监护病房入住率[比值比(odds ratio,OR)=0.34,95%CI=0.19~0.63,P<0.001]和产后出血发生率(OR=0.44,95%CI=0.28~0.69,P<0.001),缩短手术时间(MD=-16.28,95%CI=-24.89~-7.67,P<0.001)和住院时间(MD=-0.89,95%CI=-1.19~-0.59,P<0.001),但不能降低术后并发症发生率(OR=0.53,95%CI=0.16~1.80,P=0.310)和子宫切除率(OR=0.59,95%CI=0.35~1.00,P=0.050)。结论与胎儿娩出后阻断相比,剖宫产术中胎儿娩出前行腹主动脉球囊阻断对凶险性前置胎盘患者的临床价值更高,且不会增加不良妊娠结局的发生率。

Objective To systematically evaluate the clinical value of abdominal aorta balloon occlusion at different times during cesarean section in patients with dangerous placenta previa.Methods We systematically searched for literatures on abdominal aortic balloon occlusion at different times for patients with dangerous placenta previa from the establishment of database to 1 March 2024 in PubMed,Embase,Medline,Cochrane Library,Web of Science,CNKI,Wanfang Data,VIP and Chinese Biomedical Literature Database.Two reviewers independently screened the literature and extracted data.The quality of the literature was evaluated with reference to the bias risk assessment tool provided by the Cochrane Collaboration,and RevMan 5.4.1 was selected for meta-analysis.Results A total of 10 articles were included,involving 885 patients with dangerous placenta previa.The results of meta-analysis showed that pre-delivery occlusion could reduce the amount of intraoperative blood loss[mean difference(MD)=-296.89,95%confidence intervals(CI)=-433.65--160.13,P<0.001],blood transfusion(MD=-2.30,95%CI=-3.92--0.69,P=0.005),the postoperative intensive care unit admission rate[odds ratio(OR)=0.34,95%CI=0.19-0.63,P<0.001]and incidence of postpartum hemorrhage(OR=0.44,95%CI=0.28-0.69,P<0.001),shortened the operation time(MD=-16.28,95%CI=-24.89--7.67,P<0.001)and hospital stay(MD=-0.89,95%CI=-1.19--0.59,P<0.001).However,it could not reduce the incidence of postoperative complications(OR=0.53,95%CI=0.16-1.80,P=0.310)and hysterectomy rate(OR=0.59,95%CI=0.35-1.00,P=0.050).Conclusion Compared with occlusion after fetal delivery,abdominal aorta balloon occlusion before fetal delivery during cesarean section has higher clinical value for patients with dangerous placenta previa and does not increase the incidence of adverse pregnancy outcomes.