产后出血预警评分表对产后出血预测效果的Meta分析

摘要

Objective To evaluate the effects of postpartum hemorrhage (PPH )warning scoring tools. Methods Cochrane,JBI,Pubmed,Embase,CINAHL,CBM,CNKI and Wanfang databases were searched for articles from the establishment to June,2016.Prospective researches focused on warning scoring tools of PPH were included.Two researchers screened the literatures independently and data were extracted.The QUADAS was used for assessment of the internal validity of the studies.Meta-analysis was conducted with Meta-Disc 1 .4 software.Results 9 studies were included,involving 6 scoring tools and a total number of 11934puerperae.There were 3 studies included,which adopted the scale developed by Chinese PPH prevention and treatment group,for the meta-analysis of predictive accuracy.The Spearman correlation coefficient for analysis of diagnostic threshold was -0.500(P=0.667);the pooled SEN was 0.40(95%CI 0.36,0.45),with I2=91.1%(P<0.0001);the pooled SPE was 0.94(95%CI 0.93,0.94),with I2=93.8%(P<0.0001);the pooled DOR was 13.39(95%CI 7.04,25.49),with I2=77.3%(P=0.0124).Conclusions The accuracy of present warning scoring system of PPH varies a lot.The scale developed by Chinese PPH prevention and treatment group has a limited prediction compared with some modified scales,other accu-rate indicators can be used in clinical trial.%目的 系统评价不同产后出血预测评分表对孕产妇产后出血的预测效果.方法 计算机检索Cochrane图书馆、JBI系统评价数据库、Pubmed、荷兰医学文摘数据库(the excerpta medica database,Embase)、CINAHL、中国生物医学数据库(Chinese biomedical literature database,CBM)、中国期刊全文数据库(Chinese national knowledge infrastructure,CNKI)及万方数据库,选择前瞻性地将产后出血预测评分表应用于孕产妇以预测产后出血发生率的相关研究文献.检索时间均从建库开始至2016年6月.由2位评价员独立筛选文献、提取资料,并采用质量评价工具(quality assessment of diagnostic accuracy studies,QUADAS)标准进行质量评价,使用Meta-Disc 1.4统计软件进行Meta分析.结果 共纳入9项研究,包含6个评分工具,总计11934例产妇.对全国产后出血防治组制定的评分表进行Meta分析,纳入了3项研究.其阈值检验的Spearman相关系数为-0.500(P=0.667);合并效应量灵敏度为0.40(95%CI 0.36,0.45),异质性I2=91.1%(P<0.0001);特异度为0.94(95%CI 0.93,0.94),异质性I2=93.8%(P<0.0001);诊断比值比为13.39(95%CI7.04,25.49),异质性I2=77.3%(P=0.0124).结论 现有针对产后出血的预测评分表预测效果各不相同,全国产后出血防治组制定的评分表预测准确度有限,临床中可采用某些预测准确度更好的评分表.