不同分娩体位对枕后位/枕横位产妇母婴结局影响的网状Meta分析

doi:10.3761/j.issn.0254-1769.2022.20.005

摘要/Abstract

摘要：

目的采用网状Meta分析方法,评价不同分娩体位对枕后位/枕横位产妇母婴结局的影响。方法计算机检索Cochrane Library、PubMed、Web of Science、Embase、CINAHL、中国生物医学文献数据库、中国知网、维普数据库中关于不同分娩体位对枕后位/枕横位产妇分娩结局影响的随机对照试验。经过文献筛选、质量评价、信息提取后,使用R4.1.1软件和Stata16.0软件进行网状Meta分析。结果本研究共纳入24篇文献,涉及12种体位,包含4 887名产妇。网状Meta分析结果显示,同侧侧俯卧位与自由体位比较,在胎头旋转为枕前位方面差异具有显著差异（RR=0.45,95%CI为0.22~0.88）;同侧卧位与截石位比较,在阴道分娩方面差异具有显著差异（RR=0.55,95%CI为0.30~0.97）。根据累积排序概率曲线下面积排序结果,同侧卧位、同侧侧俯卧位是改善枕后位/枕横位产妇分娩结局的较优体位。结论基于网状Meta分析和排序结果,同侧卧位和同侧侧俯卧位在改善枕后位/枕横位产妇分娩结局效果较好,但还需高质量、大样本的随机对照试验进一步验证。

关键词: 分娩体位, 枕后位, 枕横位, 产妇, 母婴结局, 网状Meta分析, 产科护理

Abstract:

Objective To evaluate the effects of different maternal postures in the maternal and neonatal outcome of occiput-posterior/transverse position parturient. Methods A systematic search of Cochrane Library,PubMed,Web of Science,Embase,CINAHL,Chinese Biomedical Literature Database,CNKI and VIP was carried out. Randomized control trials（RCTs） examining the influence of different maternal postures in the maternal and neonatal outcome of occiput-posterior/transverse position parturient were included. After literature screening,quality appraisal and data extraction,the network meta-analysis was performed using R4.1.1 and Stata16.0 software. Results Totally 24 RCTs were included,involving 12 maternal postures and 4 887 parturients. The network meta-analysis showed that the homo-lateral-prone position was more effective than free position in occiput anterior position in labor（RR=0.45,95%CI 0.22~0.58）. The homo-lateral position was more effective than lithotomy position in vaginal delivery（RR=0.55,95%CI 0.30~0.97）. Probability ranking according to SUCRA showed that there was a great possibility for homo-lateral-prone position,homo-lateral position in improving the outcome of occiput-posterior/transverse position parturient. Conclusion Based on the results of network meta-analysis and rank,homo-lateral-prone position,homo-lateral position were superior than other maternal postures in improving the outcome of occiput-posterior/transverse position parturient. The results still need to be validated by high-quality and large-sample studies.

Key words: Maternal Posture, Occiput-Posterior Position, Occiput-Transverse Position, Parturient, Maternal and Neonatal Outcome, Network Meta-Analysis, Obstetrical Nursing

王雪岩, 庄云婷, 田金徽, 翟巾帼. 不同分娩体位对枕后位/枕横位产妇母婴结局影响的网状Meta分析[J]. 中华护理杂志, 2022, 57(20): 2467-2473.

WANG Xueyan, ZHUANG Yunting, TIAN Jinhui, ZHAI Jinguo. The influence of different maternal postures in the maternal and neonatal outcome of occiput-posterior/transverse position parturient：a network Meta-analysis[J]. Chinese Journal of Nursing, 2022, 57(20): 2467-2473.

图/表 3

图1 PubMed 检索策略

Figure 1 PubMed retrieval strategy

表1 纳入文献的基本特征（n=24）

Table 1 Basic characteristics of included literature（n=24）

表2 网状Meta分析排序概率

Table 2 Ranking probability diagram of network Meta-analysis

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