Segal S, Su M, Gilbert P
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Am J Obstet Gynecol. 2000 Oct;183(4):974-8. doi: 10.1067/mob.2000.106677.
This study was undertaken to quantitatively estimate the effect of a rapid introduction or withdrawal of on-demand epidural analgesia on the cesarean delivery rate.
MEDLINE and meeting abstracts were searched for studies reporting the cesarean delivery rate immediately before and after a rapid change in the availability of epidural analgesia. Nine studies reporting data on 37,753 patients were selected. Meta-analysis was performed to estimate the means and 95% confidence intervals for the changes in rates of total cesarean deliveries, cesarean deliveries among nulliparous women, cesarean deliveries for dystocia, and operative vaginal deliveries.
There was no significant change in the overall cesarean delivery rate with an increase in the availability of epidural analgesia. Similarly, the rates of cesarean deliveries among nulliparous patients, of cesarean deliveries for dystocia, and of operative vaginal deliveries did not significantly differ between periods of high and low epidural analgesia availability.
A rapid change in the availability of epidural analgesia is not associated with any increase in the cesarean delivery rate.
本研究旨在定量评估按需硬膜外镇痛的快速引入或停用对剖宫产率的影响。
检索MEDLINE和会议摘要，查找报告硬膜外镇痛可及性快速变化前后剖宫产率的研究。选择了9项报告37753例患者数据的研究。进行荟萃分析以估计总剖宫产率、初产妇剖宫产率、难产剖宫产率和阴道助产率变化的均值及95%置信区间。
随着硬膜外镇痛可及性的增加，总体剖宫产率无显著变化。同样，在硬膜外镇痛可及性高和低的时期之间，初产妇剖宫产率、难产剖宫产率和阴道助产率没有显著差异。
硬膜外镇痛可及性的快速变化与剖宫产率的任何增加均无关。
