第二产程坐式分娩对产妇分娩效果的meta分析

摘要

目的:评价产妇坐式分娩在第二产程中应用的临床效果.方法:计算机检索PubMed、Embase、CENTRAL、CINAHL、CBM、CNKI、VIP、WanFang Data数据库中有关第二产程坐式分娩的随机对照研究,检索时间均为建库至2017年2月.由两位研究者独立按纳入及排除标准筛选文献、提取资料、评价纳入研究文献的偏倚风险后,采用RevMan 5.3软件进行meta分析.结果:共纳入16个随机对照试验、3268例产妇.坐式分娩与仰卧位分娩在第二产程时间(MD=-23.02,95％CI-28.18～-17.87,P＜0.001)、剖宫产率(RR =0.50,95％CI 0.40～0.62,P＜0.001)、自然分娩率(RR=1.15,95％CI 1.07～ 1.25,P=0.000)、新生儿窒息率(RR =0.42,95％CI 0.32～0.54,P＜0.001)方面差异有统计学意义;在产后出血率方面,产床组坐式分娩与仰卧位分娩组差异无统计学意义(RR =0.81,95％CI 0.60～1.11,P=0.200),非产床组坐式分娩与仰卧位分娩组差异有统计学意义(RR=3.29,95％CI 1.72～6.26,P=0.000).结论:现有证据表明,与仰卧位分娩相比,产妇第二产程采用坐式分娩可缩短第二产程时间,促进自然分娩,减少剖官产、新生儿窒息发生,且坐式分娩使用产床不会增大产后出血的风险,但使用分娩椅等支持工具可能加大产妇产后出血.受纳入研究的文献质量的限制,上述结论尚需更多高质量的研究予以验证.%Objective:To assess the effectiveness of the sitting position during the second stage on labor of puerpera.Methods:Database such as PubMed,Embase,CENTRAL,CINAHL,CBM,CNKI,VIP,and WanFang were searched from inception to February,2017,and the randomized controlled trials (RCTs) about the effectiveness of the sitting position during the second stage of labor were collected.Two reviewers had independently selected and included literatures according to the inclusion and exclusion criteria,and also had independently extracted data and assessed the bias risk of included studies.Then,meta-analysis was conducted by RevMan 5.3 software.Results:A total of 16 RCTs which involved 3268 patients were included.Meta-analysis showed that duration of second stage(MD=-23.02,95％CI -28.18 to-17.87,P＜0.001),caesarean section rate(RR =0.50,95％CI 0.40 to 0.62,P＜0.001)、neonatal asphyxia rate(RR =0.42,95 ％CI 0.32 to 0.5),P ＜0.00001) of puerpera in the sitting position group were significantly lower than those of puerpera in the supine position group,but the rate of spontaneous labor (RR =1.15,95％CI 1.07 to 1.25),P =0.000) of puerpera in the sitting position group was significantly higher than that of puerpera in the supine position group.Subgroup analysis showed that there were no significant differences on the rate of postpartum hemorrhage (RR =0.81,95 ％ CI 0.60 to 1.11,P =0.200) between the puerpera in sitting position on obstetric bed group and the puerpera in supine position group.But there was significant differences in the rate of postpartum hemorrhage (RR =3.29,95 ％CI 1.72 to 6.26),P =0.000) between the puerpera in sitting position group and the puerpera in supine position group.Conclusion:Current evidence shows that,comparing to supine position,the effectiveness of the sitting position during the second stage of labor can shorten duration of second stage,promote natural delivery,reduce the rate of caesarean section and neonatal asphyxia.And sitting position during the second stage of labor cannot increase the risk of postpartum hemorrhage,but using obstetric chair as support tools may be increase postpartum hemorrhage.However,as the results limited by quality of included literatures,more high-quality studies should be conducted in the future to confirm the above conclusion.