摘要
目的系统评价阿托西班治疗先兆早产的疗效与安全性。方法计算机检索h e Cochrane Library、EMbase、PubMed、CBM、CNKI、WanFang Data和VIP等数据库,纳入关于阿托西班治疗先兆早产的随机对照试验(RCT),检索时限均为建库至2012年10月。由2名评价者按照纳入与排除标准独立进行文献筛选、资料提取和方法学质量评价后,采用RevMan 5.2软件进行Meta分析。结果最终纳入11个RCT,共2542例先兆早产患者。Meta分析结果显示:阿托西班在用药48小时[OR=1.33,95%CI(1.06,1.66),P=0.01]和7天的有效率[OR=1.36,95%CI(1.12,1.65),P=0.002]和母体对药物的耐受性[48小时:OR=1.65,95%CI(1.34,2.06),P<0.01;7天:OR=1.65,95%CI(1.34,2.02),P<0.01]均显著好于β2肾上腺素受体激动剂,但其有效率与钙离子拮抗剂相似[48小时:OR=0.94,95%CI(0.55,1.60),P=0.82;7天:OR=0.92,95%CI(0.53,1.60),P=0.77];阿托西班治疗后的分娩孕周[MD=0.20,95%CI(–0.16,0.56),P=0.27]、母体心血管副作用的发生率[OR=0.07,95%CI(0.01,1.05),P=0.05]、新生儿出生体重[MD=–13.20,95%CI(–77.84,51.44),P=0.69]、窒息率[OR=2.08,95%CI(0.89,4.87),P=0.09]、败血症[OR=0.78,95%CI(0.54,1.14),P=0.20]和呼吸窘迫综合征的发生率[OR=1.03,95%CI(0.65,1.65),P=0.89]与β2肾上腺受体激动剂无显著差异,但其母体心血管副作用的发生率显著低于钙离子拮抗剂[OR=0.0014,95%CI(0.02,0.82),P=0.05]。结论阿托西班抑制宫缩的疗效较其他宫缩抑制剂明显,对母体副作用少、治疗先兆早产更为安全,鉴于其对子宫的高度特异性,可作为治疗急性早产性宫缩的一线用药。
ObjectiveTo systematically review the effectiveness and safety of atosiban in the treatment of threatened premature labor. MethodsWe electronically searched databases including The Cochrane Library, EMbase, PubMed, CBM, CNKI, WanFang Data and VIP for randomized controlled trials （RCTs） on atosiban for threatened premature labor from inception to October 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 11 RCTs involving 2 542 cases of threatened preterm labor were included. The results of meta-analyses showed that atosiban was superior to β2adrenergic receptor agonists in effectiveness （48 h： OR=1.33, 95%CI 1.06 to 1.66, P=0.01; 7 d： OR=1.36, 95%CI 1.12 to 1.65, P=0.002） and maternal tolerability （48 h： OR=1.65, 95%CI 1.34 to 2.06, P〈0.01; 7 d： OR=1.65, 95%CI 1.34 to 2.02, P〈0.01）, but its effectiveness was similar to calcium antagonists （48 h： OR=0.94, 95%CI 0.55 to 1.60, P=0.82; 7 d： OR=0.92, 95%CI 0.53 to 1.60, P=0.77）. There were no significant differences in gestational age （MD=0.20, 95%CI –0.16 to 0.56, P=0.27）, the incidence of cardiovascular adverse effects in the mother’s body （OR=0.07, 95%CI 0.01 to 1.05, P=0.05）, birth weight （MD= –13.20, 95%CI –77.84 to 51.44, P=0.69）, and the incidences of asphyxia （OR=2.08, 95%CI 0.89 to 4.87, P=0.09）, sepsis （OR=0.78, 95%CI 0.54 to 1.14, P=0.20） and respiratory distress syndrome （OR=1.03, 95%CI 0.65 to 1.65, P=0.89） between the atosiban and β2adrenergic receptor agonist groups. But its incidence of cardiovascular adverse effects in the mother’s body was significantly lower than calcium antagonists （OR=0.001 4, 95%CI 0.02 to 0.82, P=0.05）. ConclusionAtosiban is better than other tocolytics in controlling the uterine contraction, and it could significantly prolong gestational age, with les
出处
《中国循证医学杂志》
CSCD
2014年第1期85-93,共9页
Chinese Journal of Evidence-based Medicine
关键词
阿托西班
先兆早产
系统评价
META分析
随机对照试验
Atosiban
Threatened premature labor
Systematic review
Meta-analysis
Randomized controlled trial
