摘要
[目的]系统评价瘢痕子宫孕妇进行阴道试产对母婴分娩结局的影响。[方法]计算机检索中国期刊全文数据库(CBM)、中国知网(CNKI)、维普(VIP)、万方(WanFang Data)、PubMed、CENTRAL、EMbase、Web of Science、CINAHL等数据库中有关瘢痕子宫再次妊娠分娩的随机对照试验,检索时间为建库至2018年7月18日。由2名研究者独立按照一定的纳入和排除标准选取、筛选文献,采用RevMan5.3软件对选取的文献进行统计分析。[结果]最终纳入13项随机对照试验,共2 666例病人,其中7项研究为瘢痕子宫阴道试产与瘢痕子宫剖宫产母婴结局比较的试验研究,6项研究为瘢痕子宫阴道试产与非瘢痕子宫阴道试产母婴结局比较的试验研究。Meta分析结果显示:瘢痕子宫阴道试产与瘢痕子宫剖宫产产褥感染发生率[RD=-0.10,95%CI(-0.14^-0.06),P<0.000 01]、住院时间[SMD=-1.27,95%CI(-1.54^-1.01),P<0.000 01]差异有统计学意义,新生儿窒息率[RD=-0.04,95%CI(-0.09~0.00),P=0.06]差异无统计学意义。瘢痕子宫阴道试产自然分娩率与非瘢痕子宫阴道试产相比,差异有统计学意义[RD=-0.09,95%CI(-0.13^-0.05),P <0.000 1]。[结论]瘢痕子宫阴道试产可降低产褥感染率,缩短住院时间,不增加新生儿窒息率,母婴结局良好。但受纳入研究内容、质量限制,尚需开展更多高质量研究予以验证。
Objective:To systematically evaluate the effects of vaginal trial production after previous caesarean on maternal and neonatal outcomes.Methods:Relevant databases ,including of the CBM,CNKI,VIP,WanFang Data,PubMed,CENTRAL,Embase,Web of Science,CINAHL,were retrieved from the databases establishment to July 18,2018.And the randomized controlled trials were collected.According to the inclusion and exclusion criteria,these literatures were selected and screened by two independent researchers.The RevMan5.3 software was used to conduct a statistic analysis.Results:A total of 13 randomized controlled trials,involving 2 666 patients,were included.Seven trials were the comparative studies on maternal and neonatal outcomes between scar uterus vaginal trial production and scar uterine cesarean delivery.Six trials were the comparative studies on maternal and neonatal outcomes between scar uterus vaginal trial production and non-scar uterine vaginal trial production.Meta-analysis showed that the incidence of puerperal infection between scar uterus vaginal trial production and scar uterine cesarean delivery(RD=-0.10,95%CI:-0.14^-0.06,P<0.000 01)and the duration in hospital(SMD=-1.27,95%CI:-1.54^-1.01,P<0.000 01)were statistically significant.However, there was no difference on neonatal asphyxia rate between them(RD=-0.04,95%CI:-0.09~0.00,P=0.06).The rates of natural delivery between scar uterus vaginal trial production and non.scar uterus were different statistically(RD=-0.09,95%CI:-0.13^-0.05,P<0.000 01).Conclusions:Scar uterus vaginal trial production can reduce the rate of puerperal infection,shorten the time of hospitalization and increase the rate of neonatal asphyxia.The outcomes of maternal and neonatal are good.However ,due to the limits of contents and the qualities of the studies,more high quality studies are further needed to confirm the above conclusions.
作者
张秋实
朱桐梅
ZHANG Qiushi;ZHU Tongmei(Suzhou Vocational Health College,Jiangsu 215009 China)
出处
《护理研究》
北大核心
2019年第19期3296-3301,共6页
Chinese Nursing Research
基金
苏州卫生职业技术学院2013年度院级立项科技创新团队建设资助项目，编号：szwzytd201305
关键词
瘢痕子宫
阴道试产
分娩方式
母婴结局
系统评价
META分析
Scar uterus
vaginal trial production
delivery mode
maternal and neonatal outcomes
systematic evaluation
meta-analysis
