用于脊髓麻醉下剖宫产术中产妇低血压管理的血管升压药：一项系统评价和网状Meta分析方案
Vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia: A Systematic review and network meta-analysis protocol.
作者信息
Ryu Choongun, Choi Geun Joo, Park Yong Hee, Kang Hyun
机构信息
Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea.
出版信息
Medicine (Baltimore). 2019 Jan;98(1):e13947. doi: 10.1097/MD.0000000000013947.
BACKGROUND
Spinal anesthesia is the standard technique for elective cesarean section, but the incidence of maternal hypotension in this setting is reportedly about 80%, without any prophylactic management. Vasopressors are the most reliable method for counteracting the hypotension induced by spinal anesthesia. However, studies investigating the effects of vasopressors have yielded inconsistent and debatable results. Therefore, we plan to conduct a systematic review and network meta-analysis to identify the most effective vasopressor to prevent maternal hypotension, and to decrease fetal acidosis in women undergoing spinal anesthesia for elective cesarean section.
METHODS
A systematic and comprehensive search to detect all the randomized controlled studies on vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia will be performed using information in the databases, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, beginning from their inception to October 2018. We will conduct a network meta-analysis to combine the direct and indirect comparisons of the vasopressors. We will use the surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of vasopressors. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool. All statistical analyses will be performed using Stata SE version 15.0.
ETHICS AND DISSEMINATION
This systematic review and meta-analysis will be published in a peer-reviewed journal. Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care.
TRIAL REGISTRATION NUMBER
The protocol for this review has been registered in the PROSPERO network (registration number: CRD42018111852).
背景
脊髓麻醉是择期剖宫产的标准技术，但据报道在此情况下产妇低血压的发生率约为80%，且未进行任何预防性处理。血管升压药是对抗脊髓麻醉引起的低血压最可靠的方法。然而，研究血管升压药作用的研究结果并不一致且存在争议。因此，我们计划进行一项系统评价和网状Meta分析，以确定预防产妇低血压并减少接受择期剖宫产脊髓麻醉的女性胎儿酸中毒的最有效血管升压药。
方法
将利用MEDLINE、EMBASE、Cochrane对照试验中央注册库（CENTRAL）和谷歌学术等数据库中的信息，从其创建之初至2018年10月进行系统全面的检索，以查找所有关于血管升压药用于脊髓麻醉下剖宫产时处理产妇低血压的随机对照研究。我们将进行网状Meta分析，以合并血管升压药的直接和间接比较。我们将使用累积排序曲线下面积（SUCRA）值和排序图来呈现血管升压药的等级。将使用比较调整漏斗图来评估小研究效应的存在。将使用偏倚风险工具评估纳入研究的质量。所有统计分析将使用Stata SE 15.0版本进行。
伦理与传播
本系统评价和Meta分析将发表在同行评审期刊上。由于该研究将是一项文献综述，不涉及与患者的直接接触或对患者护理的改变，因此无需伦理批准和知情同意。
试验注册号
本综述方案已在PROSPERO网络注册（注册号：CRD42018111852）。
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