国际妇产科学杂志

国际妇产科学杂志 ›› 2017, Vol. 44 ›› Issue (5): 552-559.

• 论著 • 上一篇    下一篇

自由体位分娩对母婴分娩结局影响的Meta分析

肖青青,高静,李幸,余静雅,郭潇潇,刘洁   

  1. 611137  成都中医药大学护理学院
  • 收稿日期:2017-06-08 修回日期:2017-07-11 出版日期:2017-10-15 发布日期:2017-10-25
  • 通讯作者: 高静，E-mail：729012934@qq.com E-mail:729012934@qq.com

Effects of Free Position in the Labor on Maternal and Neonatal Birth Outcomes: A Meta-analysis

XIAO Qing-qing，GAO Jing，LI Xing，YU Jing-ya，GUO Xiao-xiao，LIU Jie   

  1. School of Nursing，Chengdu University of Traditional Chinese Medicine，Chengdu 611137，China
  • Received:2017-06-08 Revised:2017-07-11 Published:2017-10-15 Online:2017-10-25
  • Contact: GAO Jing，E-mail：729012934@qq.com E-mail:729012934@qq.com

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被引次数

31

摘要： 目的：系统评价初产妇在产程中实施自由体位分娩对母婴结局的影响。方法：计算机检索PubMed、Embase、CENTRAL、Web of Science、CINAHL、CBM、CNKI、VIP、WanFang Data数据库中有关自由体位分娩的随机对照试验，检索时间均为建库至2017年4月4日。由2名研究者独立按纳入、排除标准筛选文献、提取资料、评价纳入研究的偏倚风险后，采用RevMan 5.3软件进行Meta分析。结果：共纳入18项随机对照试验，3 603例患者。Meta分析结果显示：自由体位分娩与常规卧位分娩在总产程时间（MD=-2.98，95%CI：-3.29～-2.68，P＜0.000 01）、剖宫产率（RR=0.43，95%CI：0.37～0.51，P＜0.000 01）、自然分娩率（RR=1.33，95%CI：1.27～1.39，P＜0.000 01）、产后出血发生率（RR=0.25，95%CI：0.15～0.40，P＜0.000 01）、会阴Ⅲ度裂伤发生率（RR=0.33，95%CI：0.17～0.67，P=0.002）、宫颈裂伤发生率（RR=0.34，95%CI：0.21～0.55，P＜0.000 01）、新生儿窒息率（RR=0.31，95%CI：0.21～0.47，P＜0.000 01）、新生儿颅内出血发生率（RR=0.22，95%CI：0.08～0.57，P=0.002）比较，差异有统计学意义；新生儿吸入综合征发生率（RR=0.73，95%CI：0.30～1.80，P=0.50）比较差异无统计学意义。结论：与常规卧位分娩相比，初产妇产程中采用自由体位分娩可缩短总产程时间，提高自然分娩率，降低剖宫产率，减少产后出血、软产道损伤，降低新生儿窒息和颅内出血的发生率，并且不会增加新生儿吸入综合征的风险。但受纳入研究质量限制，上述结论尚需开展更多高质量研究予以验证。

关键词: 产次, 分娩, Meta分析, 初产妇, 自由体位

Abstract: Objective: To evaluate the effect of free position during labor on maternal and neonatal outcomes on primipara. Methods: We searched the PubMed, Embase, CENTRAL, Web of Science, CINAHL, CBM, CNKI, VIP, WanFang Data from inception to April, 2017, to collect the randomized controlled trials (RCTs) in which the use of the free position during the labor on primipara. Two reviewers independently selected and included literatures according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was conducted by RevMan 5.3 software. Results: A total of 18 RCTs involving 3 603 patients were included. Meta-analysis showed that duration of labor (MD=-2.98, 95%CI: -3.29～-2.68, P＜0.000 01), caesarean section rate (RR=0.43, 95%CI: 0.37～0.51, P＜0.000 01), postpartum hemorrhage rate (RR=0.25, 95%CI: 0.15～0.40, P＜0.000 01), the rate of third degree laceration of perineum (RR=0.33, 95%CI: 0.17～0.67, P=0.002), cervical laceration rate (RR=0.34, 95%CI: 0.21～0.55, P＜0.000 01), neonatal asphyxia rate (RR=0.31, 95%CI: 0.21～0.47, P＜0.000 01), neonatal intracranial hemorrhage rate (RR=0.22, 95%CI: 0.08～0.57, P=0.002) in the free position group were significantly lower than those in the conventional supine position group. There were no significant differences on the incidence of neonatal aspiration syndrome (RR=0.73, 95%CI: 0.30～1.80, P=0.50) in two groups of the study. Conclusions：Current evidence shows that, comparing to conventional supine position, free position on primipara can shorten duration of labor, and promote spontaneous labor, reduce the caesarean section, postpartum hemorrhage, laceration of birth canal, neonatal asphyxia, and neonatal intracranial hemorrhage, moreover, not increase postpartum hemorrhage. However, because limitation of quality of included studies, more high-quality studies are needed to confirm the above conclusion.

Key words:  Parity；Parturition, Meta-analysis, Primipara, Free position