卡贝缩宫素对阴道分娩后产后出血的影响：一项荟萃分析。
Effect of Carbetocin on Postpartum Hemorrhage after Vaginal Delivery: A Meta-Analysis.
机构信息
Department of Pediatrics, Haikou Maternal and Child Health Hospital, Haikou, Hainan 570203, China.
Department of Obstetrics and Gynecology, Hainan Western Central Hospital, Danzhou, Hainan 571700, China.
出版信息
Comput Math Methods Med. 2022 Jun 20;2022:6420738. doi: 10.1155/2022/6420738. eCollection 2022.
BACKGROUND
The efficacy of oxytocin and carbetocin in preventing postpartum hemorrhage (PPH) in women with vaginal delivery has been controversial. This study is aimed at conducting a meta-analysis that compares the efficacy of carbetocin and oxytocin in the prevention of PPH among women with vaginal delivery.
METHODS
Literature was retrieved from PubMed, Medline, Embase, CENTRAL, and CNKI databases. The randomized controlled trials (RCTs) that compare the efficacy of carbetocin and oxytocin to prevent PPH were searched. Data from the included literatures were extracted by two researchers, including author, title, publication date, study type, study number, the incidence of PPH, number of patients requiring additional uterotonics, and number of patients requiring blood transfusion. Jadad scale was used to evaluate the quality of the included RCTs. The Chi-square test was adopted for the heterogeneity test. A fixed-effect model was used for analysis if heterogeneity did not exist between literatures. If heterogeneity exists between literatures, a random-effect model was used for analysis. The source of heterogeneity was explored by subgroup analysis and sensitivity analysis.
RESULTS
The incidence of PPH in the carbetocin group was lower than that in the oxytocin group (OR = 0.62, 95% CI (0.46, 0.84), = 3.14, = 0.002). There was no heterogeneity among studies ( = 7.29, = 0.12, = 45%) and no significant publication bias ( > 0.05). The proportion of women requiring additional uterotonics in the carbetocin group was lower than that in the oxytocin group (OR = 0.41, 95% CI (0.29, 0.56), = 5.34, < 0.00001). There was no heterogeneity among studies ( = 0.82, = 0.84, = 0%) and no significant publication bias ( > 0.05). There was no significant difference in the proportion of women needing blood transfusion between the carbetocin group and the oxytocin group (OR = 0.92, 95% CI (0.66, 1.29), = 0.46, = 0.64). There was no heterogeneity among studies ( = 3.06, = 0.55, = 0%) and no significant publication bias ( > 0.05).
CONCLUSION
Carbetocin is superior to oxytocin in preventing PPH among women with vaginal delivery and can be widely used in clinical practice.
背景
缩宫素和卡贝缩宫素在预防阴道分娩产后出血（PPH）方面的疗效一直存在争议。本研究旨在进行一项荟萃分析，比较卡贝缩宫素和缩宫素在预防阴道分娩妇女 PPH 中的疗效。
方法
从 PubMed、Medline、Embase、CENTRAL 和中国知网（CNKI）数据库中检索比较卡贝缩宫素和缩宫素预防 PPH 疗效的随机对照试验（RCT）。提取纳入文献的数据，包括作者、标题、发表日期、研究类型、研究数量、PPH 发生率、需要额外使用宫缩剂的患者数量和需要输血的患者数量。采用 Jadad 量表评价纳入 RCT 的质量。采用卡方检验进行异质性检验。如果文献之间不存在异质性，则采用固定效应模型进行分析。如果文献之间存在异质性，则采用随机效应模型进行分析。通过亚组分析和敏感性分析探索异质性的来源。
结果
卡贝缩宫素组 PPH 发生率低于缩宫素组（OR = 0.62，95%CI（0.46，0.84）， = 3.14， = 0.002）。研究间无异质性（ = 7.29， = 0.12， = 45%），无显著发表偏倚（ > 0.05）。卡贝缩宫素组需要额外使用宫缩剂的患者比例低于缩宫素组（OR = 0.41，95%CI（0.29，0.56）， = 5.34， < 0.00001）。研究间无异质性（ = 0.82， = 0.84， = 0%），无显著发表偏倚（ > 0.05）。卡贝缩宫素组和缩宫素组需要输血的患者比例无显著差异（OR = 0.92，95%CI（0.66，1.29）， = 0.46， = 0.64）。研究间无异质性（ = 3.06， = 0.55， = 0%），无显著发表偏倚（ > 0.05）。
结论
卡贝缩宫素预防阴道分娩妇女 PPH 的疗效优于缩宫素，可广泛应用于临床实践。
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