摘要
目的:系统评价米索前列醇对比缩宫素预防产后出血的临床有效性及安全性,为临床用药提供循证参考。方法:计算机检索中国知网、维普网、万方数据库、中国生物医学文献数据库、PubMed、Embase、CochraneLibrary,检索时限均为建库起至2021年2月15日,收集国内外公开发表的关于米索前列醇对比缩宫素预防产后出血的临床有效性及安全性的临床随机对照试验(RCT)。对检索获得的文献根据纳入与排除标准进行筛选和质量评价,并采用RevMan5.3软件进行Meta分析。结果:共纳入14项RCT,合计25732例产妇。Meta分析结果显示,米索前列醇组产妇在平均出血量[MD=14.96,95%CI(-2.62,32.54),P=0.10]、第三产程时间[MD=-0.03,95%CI(-0.19,0.13),P=0.69]、输血率[RR=0.91,95%CI(0.74,1.12),P=0.37]、恶心发生率[RR=1.06,95%CI(0.85,1.31),P=0.60]方面与缩宫素组比较,差异均无统计学意义;但是寒战发生率[RR=2.99,95%CI(2.22,4.04),P<0.00001]、发热发生率[RR=4.31,95%CI(2.79,6.67),P<0.00001]、呕吐发生率[RR=2.16,95%CI(1.63,2.88),P<0.00001]、腹泻发生率[RR=2.67,95%CI(1.79,3.98),P<0.00001]均显著高于缩宫素组。结论:米索前列醇预防产后出血的效果与缩宫素相当,但是不良反应发生率较高,在使用过程中需密切关注不良反应发生情况。由于纳入的研究存在一定的局限性,今后仍需多中心、大样本、高质量的RCT进一步验证本结论。
OBJECTIVE:To systematically evaluate the c linical efficacy and safety of misoprostol versus oxytocin in preventing postpartum hemorrhage,and to provide evidence-based reference for clinical drug use.METHODS:Retrieved from CNKI,VIP,Wanfang database,CBM,PubMed,Embase and the Cochrane Library,randomized controlled trials(RCTs)published at home and abroad about clinical efficacy and safety of misoprostol and oxytocin in preventing postpartum hemorrhage were collected during the inception to Feb.15th,2021.According to the inclusion and exclusion criteria,the included studies were screened and evaluated.RevMan 5.3 software was used for Meta-analysis.RESULTS:A total of 14 RCTs involving 25732 lying-in women were included.The results of Meta-analysis showed that compared with oxytocin group,there was no difference in the mean blood loss(MD=14.96,95%CI(-2.62,32.54),P=0.10),the time of the third stage of labor(MD=-0.03,95%CI(-0.19,0.13),P=0.69),the incidence of blood transfusion(RR=0.91,95%CI(0.74,1.12),P=0.37)or the incidence of nausea(RR=1.06,95%CI(0.85,1.31),P=0.60)in misoprostol group;but the incidence of shivering(RR=2.99,95%CI(2.22,4.04),P<0.00001),the incidence of fever(RR=4.31,95%CI(2.79,6.67),P<0.00001),the incidence of vomiting(RR=2.16,95%CI(1.63,2.88),P<0.00001)and the incidence of diarrhea(RR=2.67,95%CI(1.79,3.98),P<0.00001)in misoprostol group were higher.CONCLUSIONS:The effect of misoprostol in the prevention of postpartum hemorrhage is similar to oxytocin,but the incidence of ADR is higher.It is necessary to pay close attention to the adverse reactions during use.Due to the limitation of included studies,multi-center,large-scale and high-quality RCTs are needed for further validation.
作者
董魏徵
董敏
陈海燕
徐萌艳
DONG Weizheng;DONG Min;CHEN Haiyan;XU Mengyan(Dept,of Pharmacy,Hangzhou Linping District Hospital of Integrated Chinese and Western Medicine,Hangzhou 311199,China;Physical Examination Center,Hangzhou Linping District Hospital of Integrated Chinese and Western Medicine,Hangzhou 311199,China;Dept,of Nursing,Hangzhou Obstetrics and Gynecology Hospital,Hangzhou 310016,China)
出处
《中国药房》
CAS
北大核心
2021年第21期2655-2661,共7页
China Pharmacy
基金
浙江省自然科学基金杰出青年科学基金项目(No.LR19C060001)。
