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不同干预措施降低分娩疼痛的效果比较：系统评价和网络荟萃分析。

Comparison of different interventions for the reduction of labor pain: A systematic review and network meta-analysis.

机构信息

Anesthesiology Department, Chongqing KangHuaZhongLian Cardiovascular Hospital, Chongqing, China.

出版信息

Medicine (Baltimore). 2024 Mar 8;103(10):e37047. doi: 10.1097/MD.0000000000037047.

DOI:10.1097/MD.0000000000037047
PMID:38457589
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10919462/
Abstract

OBJECTIVE

This systematic review and network meta-analysis were performed to compare different interventions for the reduction of labor pain.

METHODS

PubMed, Embase, Cochrane Library, Web of Science and ScienceDirect databases were searched for the randomized controlled trials (RCTs) meeting prespecified inclusion criteria up to January, 2023. Interventions including electrical acupoint stimulation (TEAS), epidural analgesia (EA) and control treatments. The primary outcomes included pain scores, failure rate of natural delivery, adverse events and Apgar scores. The methodological quality was assessed by the Cochrane risk of bias tool. Meta-analysis was performed by R software with gemtc package. Surfaces under the cumulative ranking curves (SUCRA) were used to rank the intervention.

RESULTS

Twelve studies met the inclusion criteria and were included in the network meta-analysis. TEAS (WMD -3.1, 95% CrI -3.8, -2.5) and EA (WMD -2.1, 95% CrI -2.8, -1.3) was more effective than the control in decreasing VAS. TEAS ranked first (SUCRA, 90.9%), EA ranked second (SUCRA, 74.0%) and control ranked last (SUCRA, 35.0%) for reducing VAS. For patients with labor pain, with respect to the most effective treatment for reducing failure rate of natural delivery, TEAS ranked first (SUCRA, 96.6%), EA ranked second (SUCRA, 50.4%) and control ranked last (SUCRA, 3.0%). With regard to the Apgar scores, there was high probability that TEAS ranked first (SUCRA, 80.7%), compared to control (SUCRA, 41.4%) and EA (SUCRA 27.9%). With regard to the adverse events, there was high probability that TEAS ranked first (SUCRA, 99.9%), compared to control (SUCRA, 33.2%) and EA (SUCRA 17.6%).

CONCLUSION

TEAS has the potential to serve as a viable alternative for women in labor, offering a simple, noninvasive, and non-pharmacological intervention that surpasses EA in terms of both analgesic effectiveness and safety for both mothers and neonates.

摘要

目的

本系统评价和网络荟萃分析旨在比较不同干预措施对减轻分娩疼痛的效果。

方法

检索了符合预定义纳入标准的随机对照试验（RCT），检索数据库包括 PubMed、Embase、Cochrane 图书馆、Web of Science 和 ScienceDirect，检索时间截至 2023 年 1 月。干预措施包括电穴位刺激（TEAS）、硬膜外镇痛（EA）和对照治疗。主要结局指标包括疼痛评分、自然分娩失败率、不良事件和 Apgar 评分。采用 Cochrane 偏倚风险工具评估方法学质量。采用 R 软件中的 gemtc 包进行荟萃分析。累积排序曲线下面积（SUCRA）用于对干预措施进行排名。

结果

共有 12 项研究符合纳入标准，并纳入网络荟萃分析。TEAS（WMD -3.1，95%CrI -3.8，-2.5）和 EA（WMD -2.1，95%CrI -2.8，-1.3）比对照组更能有效降低 VAS。TEAS 排名第一（SUCRA，90.9%），EA 排名第二（SUCRA，74.0%），对照组排名最后（SUCRA，35.0%），用于降低 VAS。对于有分娩疼痛的患者，在最有效的治疗方法中，TEAS 排名第一（SUCRA，96.6%），EA 排名第二（SUCRA，50.4%），对照组排名最后（SUCRA，3.0%），用于降低自然分娩失败率。关于 Apgar 评分，TEAS 很可能排名第一（SUCRA，80.7%），而对照组（SUCRA，41.4%）和 EA（SUCRA，27.9%）。关于不良事件，TEAS 很可能排名第一（SUCRA，99.9%），而对照组（SUCRA，33.2%）和 EA（SUCRA，17.6%）。

结论

TEAS 有可能成为分娩妇女的一种可行替代方案，提供一种简单、非侵入性、非药物性的干预措施，在镇痛效果和母婴安全性方面均优于 EA。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970d/10919462/236309a84cf2/medi-103-e37047-g008.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970d/10919462/236309a84cf2/medi-103-e37047-g008.jpg
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