腹带在减轻剖宫产术后疼痛和不适中的效果：一项随机对照试验的荟萃分析。

The efficacy of abdominal binders in reducing postoperative pain and distress after cesarean delivery: A meta-analysis of randomized controlled trials.

机构信息

Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2021 Jul;262:73-79. doi: 10.1016/j.ejogrb.2021.05.014. Epub 2021 May 9.

DOI:10.1016/j.ejogrb.2021.05.014

PMID:33993065

Abstract

OBJECTIVE

To evaluate the efficacy of abdominal binders in reducing postoperative pain, patient distress and surgical postoperative sequelae after cesarean delivery (CD).

METHODS

A comprehensive search in electronic databases (MEDLINE, EMBASE, and Cochrane Central) was performed up to February 2021. Selection criteria included randomized clinical trials investigating the application or not of abdominal binder after CD. The primary outcome was postoperative pain, measured using the visual analog scale (VAS) pain score. Secondary outcomes were divided into short- and long-term postoperative outcomes, including patient distress, need for additional pain medications, time to mobilization, return to normal daily activities, surgical site infection, fascial dehiscence or incisional hernia, and rectus abdominis diastasis. The summary measures were reported as mean difference with 95 % confidence intervals (CI) using the random effects model of DerSimonian and Laird. An I (Higgins I) value of greater than 0% was used to identify heterogeneity.

RESULTS

Four RCTs involving 601 women were included for meta-analysis: 310 (51.6 %) were randomized to the abdominal binder and 291 (48.4 %) to no abdominal binder group. There was no statistically significant difference between the two groups for VAS score either at 24 h (MD -0.97, 95 % CI -2.23 to 0.30; p = 0.13) and at 48 h (MD -0.30, 95 % CI -0.71 to 0.11; p = 0.15). Conversely, there was a significant reduction in postoperative distress (SDS) both at 24 h (MD -2.23, 95 % CI -3.77 to -0.70; p = 0.004) and 48 h (MD -2.37, 95 % CI -3.86 to -0.87; p = 0.002).

CONCLUSION

The present meta-analysis shows that the use of abdominal binders after CD significantly reduces patient distress.

摘要

目的

评估腹部束带在减轻剖宫产（CD）术后疼痛、患者痛苦和手术后遗症方面的疗效。

方法

对 MEDLINE、EMBASE 和 Cochrane 中央数据库进行全面检索，检索时间截至 2021 年 2 月。纳入标准为研究腹部束带在 CD 后应用或不应用的随机临床试验。主要结局为使用视觉模拟评分（VAS）测量的术后疼痛。次要结局分为短期和长期术后结局，包括患者痛苦、需要额外的止痛药、开始活动的时间、恢复正常日常活动、手术部位感染、筋膜裂开或切口疝、腹直肌分离。汇总措施以随机效应模型的 DerSimonian 和 Laird 表示为均数差和 95%置信区间（CI）。使用 Higgins I 值大于 0%来识别异质性。

结果

纳入了 4 项 RCT，共 601 名女性进行荟萃分析：310 名（51.6%）被随机分配到腹部束带组，291 名（48.4%）分到无腹部束带组。两组在 24 小时（MD-0.97，95%CI-2.23 至 0.30；p=0.13）和 48 小时（MD-0.30，95%CI-0.71 至 0.11；p=0.15）的 VAS 评分上无统计学差异。相反，术后疼痛评分（SDS）在 24 小时（MD-2.23，95%CI-3.77 至-0.70；p=0.004）和 48 小时（MD-2.37，95%CI-3.86 至-0.87；p=0.002）均显著降低。