Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China.
J Clin Pharm Ther. 2022 Jul;47(7):1036-1048. doi: 10.1111/jcpt.13641. Epub 2022 Mar 18.
Premature birth affects more than 15 million infants, as well as mothers and families around the world. With the relaxation of the two-child policy, the problem of premature birth has become relatively prominent in China. According to statistics, China had a birth population of 15.23 million in 2018, with a considerably large number of premature births. This study aims to evaluate the efficacy and safety of tocolysis in the treatment of preterm delivery, provide clinical evidence for medical staff and promote the self-management of patients with premature births.
Four English databases (PubMed, Embase, Cochrane Library and Web of Science) were retrieved by computer, the retrieval time was from the establishment of each database to November 2021, and the randomized controlled trials for the treatment of preterm delivery were screened according to the pre-set natriuretic exclusion criteria. After literature screening, data selection and risk of bias evaluation were independently conducted by two researchers. R 4.1.1 and Stata 17.0 software were used for statistical analysis.
A total of 44 RCTs were included, including 6939 patients. The results of network meta-analysis reveal that in terms of effectiveness, indomethacin was the most effective intervention measure, followed by nifedipine, and the difference was statistically significant; regarding safety, nifedipine was the safest intervention measure, followed by indomethacin, and the difference was statistically significant; and in respect of adverse reactions, ritodrine had the highest probability, and the difference was statistically significant.
Nifedipine may be better for delayed delivery and less likely to produce adverse pregnancy outcomes, followed by indomethacin. Limited by the number and quality of recipient studies, the aforementioned conclusions need to be verified through more high-quality studies. At the same time, the focus should be on patients with twin pregnancy and patients with clinical manifestations of extreme preterm delivery.
早产影响全球超过 1500 万婴儿以及母亲和家庭。随着二孩政策的放宽，早产问题在中国变得相对突出。据统计，中国 2018 年出生人口为 1523 万，早产儿数量相当多。本研究旨在评估早产治疗中抑制宫缩的疗效和安全性，为医务人员提供临床证据，并促进早产儿患者的自我管理。
计算机检索 4 个英文数据库（PubMed、Embase、Cochrane Library 和 Web of Science），检索时间从各数据库建立到 2021 年 11 月，根据预设的利钠肽排除标准筛选治疗早产的随机对照试验。文献筛选后，由两名研究人员独立进行数据选择和偏倚风险评估。使用 R 4.1.1 和 Stata 17.0 软件进行统计分析。
共纳入 44 项 RCT，共 6939 例患者。网络荟萃分析结果显示，在有效性方面，吲哚美辛是最有效的干预措施，其次是硝苯地平，差异有统计学意义；安全性方面，硝苯地平是最安全的干预措施，其次是吲哚美辛，差异有统计学意义；不良反应方面，利托君的概率最高，差异有统计学意义。
硝苯地平可能更有利于延迟分娩，且不太可能产生不良妊娠结局，其次是吲哚美辛。受纳入研究数量和质量的限制，上述结论需要通过更多高质量的研究来验证。同时，应关注双胎妊娠患者和临床表现为极早产的患者。
