妊娠相关下腰痛预防与管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2021.06.023

摘要/Abstract

摘要：

目的检索并获取妊娠相关下腰痛预防及管理的相关证据,为临床提供参考。方法系统检索相关网站、数据库关于妊娠相关下腰痛预防及管理的所有证据,包括指南、最佳临床实践信息册、证据总结、系统评价及专家共识等,检索时限为建库至2020年9月。由2名研究员独立对文献进行质量评价并通过专家论证会对证据推荐级别进行评定。结果共纳入20篇文献,包括1篇临床决策、2篇指南、12篇系统评价及5篇随机对照试验,总结出27条关于妊娠相关下腰痛预防与管理的最佳证据,包括评估与诊断、日常生活管理、多学科管理、药物管理与非药物管理5个方面。结论该研究总结、形成了多学科合作的妊娠相关下腰痛预防与管理方案,证据转化时应充分结合临床环境、孕妇意愿,有针对性的选择最佳证据,降低妊娠相关下腰痛发生率、减轻疼痛。

关键词: 妊娠, 下腰痛, 妊娠并发症, 循证护理学

Abstract:

Objective To select and obtain the best evidence for pregnancy-related low back pain,so as to provide references for clinical practice to decrease the incidence and degree of pregnancy-related low back pain. Methods We systematically searched related websites,databases for all evidence on prevention and management of pregnancy-related low back pain,including guidelines,best practice information booklets,evidence summaries,system reviews,expert consensuses research from the inception of databases to September,2020. Literature was evaluated and rated for quality by 2 researchers independently. Results Totally,20 articles were enrolled,including 1 clinical decision,2 guidelines,12 systematic reviews and 5 randomized controlled trials. A total of 27 pieces of evidence were summarized,including pregnancy-related low back pain assessment and diagnosis,daily life management,multidisciplinary management,drug management and non-drug management. Conclusion A multidisciplinary cooperation plan for the prevention and management of pregnancy-related low back pain was formed. The best evidence should be selected in accordance with the clinical environment and pregnant women’s preferences,so as to reduce the incidence and degree of pregnancy-related low back pain.

Key words: Pregnancy, Low Back Pain, Pregnancy Complications, Evidence-Based Nursing

石志宜,卢颖,邢丽媛,刘纬华,王淑靖,王真真,张红梅. 妊娠相关下腰痛预防与管理的最佳证据总结[J]. 中华护理杂志, 2021, 56(6): 934-941.

SHI Zhiyi,LU Ying,XING Liyuan,LIU Weihua,WANG Shujing,WANG Zhenzhen,ZHANG Hongmei. Evidence summary for prevention and management of pregnancy-related low back pain[J]. Chinese Journal of Nursing, 2021, 56(6): 934-941.

图/表 3

表1 纳入文献的一般情况

Table 1 Characteristics of include studies

表2 指南的质量评价结果

Table 2 Quality evaluation results of guidelines

表3 妊娠相关下腰痛预防及管理的最佳证据总结

Table 3 Evidence summary for prevention and management of pregnancy-related low back pain

参考文献 40

[1]	Clark CJ, Carr EC, Way S. Pregnancy-related lumbopelvic pain:prevalence,persistence,risk factors and management implications[J]. Br J Midwifery, 2013,21(5):323-330. DOI URL
[2]	Gutke A, Boissonnault J, Brook G, et al. The severity and impact of pelvic girdle pain and low-back pain in pregnancy:a multinational study[J]. J Womens Health(Larchmt), 2018,27(4):510-517.
[3]	Stuge B. Current knowledge on low back pain and pelvic girdle pain during pregnancy and after childbirth:a narrative review[J]. Curr Women S Heal Rev, 2015,11(1):68-74.
[4]	MacKenzie J, Murray E, Lusher J. Women’s experiences of preg-nancy related pelvic girdle pain:a systematic review[J]. Midwifery, 2018,56:102-111. DOI URL
[5]	Fishburn S, Cooper T. Pelvic girdle pain:are we missing opportunities to make this a problem of the past?[J]. Br J Midwifery, 2015,23(11):774-778. DOI URL
[6]	卜秀青, 尤黎明, 颜君, 等. 产褥期妇女压力及其影响因素的研究[J]. 中华护理杂志, 2007,42(12):1065-1067.
	Bu XQ, You LM, Yan J, et al. Investigation on stress and related factors in postpartum women[J]. Chin J Nurs, 2007,42(12):1065-1067.
[7]	Bonnie LB. Maternal adaptations to pregnancy:musculoskeletal changes and pain[EB/OL]. (2020-04-01)[2020-09-11]. https://www.uptodate.com/contents/zh-Hans/maternal adaptations-to-preg-nancy-musculoskeletal-changes-and-pain?search=Mus-culo-skeletal%20chest%20pain&source=search_result&selectedTitle=7~26 &usagetype=default&display_ rank=7.
[8]	The American College of Obstericians and Gynecologists. Back pain during pregnancy[EB/OL]. (2020-05-11)[2021-01-20]. https://www.acog.org/patient-resources/faqs/pregnancy/back-pain-during-pregnancy prevention.
[9]	宋成宪, 王润妹, 李太良, 等. 妊娠相关下腰痛的流行病学特征及治疗进展[J]. 中华全科医学, 2017,15(4):659-662.
	Song CX, Wang RM, Li TL, et al. Epidemiological characteristics and therapeutic progress of pregnancy-related low back pain[J]. Chin J Gen Pract, 2017,15(4):659-662.
[10]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017,32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017,32(21):1991-1994.
[11]	韦当, 王聪尧, 肖晓娟, 等. 指南研究与评价(AGREEⅡ)工具实例解读[J]. 中国循证儿科杂志, 2013,8(4):316-319.
	Wei D, Wang CY, Xiao XJ, et al. Guideline research and eva-luation(AGREEⅡ)tool example interpretation[J]. Chin J Evid- Based Pediatr, 2013,8(4):316-319.
[12]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018: 56-93.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2th ed. Beijing: People’s Medical Publishing House, 2018: 56-93.
[13]	Clinical Guideline Subcommittee on Low Back Pain, American Osteopathic Association. American Osteopathic Association guidelines for osteopathic manipulative treatment(OMT)for patients with low back pain[J]. J Am Osteopath Assoc, 2010,110(11):653-666.
[14]	Mottola MF, Davenport MH, Ruchat SM, et al. 2019 Canadian guideline for physical activity throughout pregnancy[J]. Br J Sports Med, 2018,52(21):1339-1346. DOI URL
[15]	Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy[J]. Cochrane Database Syst Rev,2015(29):CD001139.
[16]	Peng YC, Chou FH. Different exercise intensities for relieving lumbopelvic pain in pregnant women[J]. J Nurse Pract, 2019,15(3):249-255. DOI URL
[17]	Wuytack F, O’Donovan M. Outcomes and outcomes measurements used in intervention studies of pelvic girdle pain and lumbopelvic pain:a systematic review[J]. Chiropr Man Therap, 2019,27:62. DOI URL
[18]	Davenport MH, Marchand AA, Mottola MF, et al. Exercise for the prevention and treatment of low back,pelvic girdle and lumbopelvic pain during pregnancy:a systematic review and meta-analysis[J]. Br J Sports Med, 2019,53(2):90-98. DOI PMID
[19]	Szkwara JM, Milne N, Hing W, et al. Effectiveness,feasibility,and acceptability of dynamic elastomeric fabric orthoses(DEFO)for managing pain,functional capacity,and quality of life during prenatal and postnatal care:a systematic review[J]. Int J Environ Res Public Health, 2019,16(13):e2408.
[20]	Quintero Rodriguez C, Troynikov O. The effect of maternity support garments on alleviation of pains and discomforts during pregnancy:a systematic review[J]. J Pregnancy, 2019: 2163790.
[21]	Shiri R, Coggon D, Falah-Hassani K. Exercise for the prevention of low back and pelvic girdle pain in pregnancy:a meta-analysis of randomized controlled trials[J]. Eur J Pain, 2018,22(1):19-27. DOI PMID
[22]	Kinser PA, Pauli J, Jallo N, et al. Physical activity and yoga-based approaches for pregnancy-related low back and pelvic pain[J]. J Obstet Gynecol Neonatal Nurs, 2017,46(3):334-346. DOI URL
[23]	Hall H, Cramer H, Sundberg T, et al. The effectiveness of com-plementary manual therapies for pregnancy-related back and pelvic pain:a systematic review with meta-analysis[J]. Medi-cine(Baltimore), 2016,95(38):e4723.
[24]	Franke H, Franke JD, Belz S, et al. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy:a systematic review and meta-analysis[J]. J Bodyw Mov Ther, 2017,21(4):752-762. DOI PMID
[25]	Yao X, Li C, Ge X, et al. Effect of acupuncture on pregnancy related low back pain and pelvic pain:a systematic review and meta-analysis[J]. Int J Clin Exp Med, 2017,10(4):5903-5912.
[26]	Weis CA, Pohlman K, Draper C, et al. Chiropractic care for adults with pregnancy-related low back,pelvic girdle pain,or combination pain:a systematic review[J]. J Manip Physiol Ther, 2020,43(7):714-731. DOI URL
[27]	Vas J, Cintado MC, Aranda-Regules JM, et al. Effect of ear acupuncture on pregnancy-related pain in the lower back and posterior pelvic girdle:a multicenter randomized clinical trial[J]. Acta Obstet Gynecol Scand, 2019,98(10):1307-1317. DOI URL
[28]	Kaplan Ş, Alpayci M, Karaman E, et al. Short-term effects of kinesio taping in women with pregnancy-related low back pain:a randomized controlled clinical trial[J]. Med Sci Monit, 2016,22:1297-1301. DOI URL
[29]	Holden SC, Manor B, Zhou JH, et al. Prenatal yoga for back pain,balance,and maternal wellness:a randomized,controlled pilot study[J]. Glob Adv Heal Med, 2019,8:216.
[30]	Shirazi M, Mohebitabar S, Bioos S, et al. The effect of topical Rosa damascena(rose)oil on pregnancy-related low back pain:a randomized controlled clinical trial[J]. J Evid Based Complementary Altern Med, 2017,22(1):120-126. DOI URL
[31]	Bishop A, Ogollah R, Bartlam B, et al. Evaluating acupuncture and standard care for pregnant women with back pain:the EASE back pilot randomised controlled trial(ISRCTN49955-124)[J]. Pilot Feasibility Stud, 2016,2:72. DOI URL
[32]	Bliddal M, Pottegård A, Kirkegaard H, et al. Association of pre-pregnancy body mass index,pregnancy-related weight changes,and parity with the risk of developing degenerative musculoskeletal conditions[J]. Arthritis Rheumatol, 2016,68(5):1156-1164.
[33]	George JW, Skaggs CD, Thompson PA, et al. A randomized con-trolled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy[J]. Am J Obstet Gynecol, 2013,208(4):295-296.
[34]	刘婷, 谭小雪, 徐娜飞, 等. 妊娠期糖尿病孕妇运动方案的最佳证据总结[J]. 中华护理杂志, 2020,55(10):1514-1519.
	Liu T, Tan XX, Xu NF, et al. Evidence summary of exercise regimens for patients with gestational diabetes mellitus[J]. Chin J Nurs, 2020,55(10):1514-1519.
[35]	Sheraton A, Streckfuss J, Grace S. Experiences of pregnant wo-men receiving osteopathic care[J]. J Bodyw Mov Ther, 2018,22(2):321-327. DOI PMID
[36]	Nicolian S, Butel T, Gambotti L, et al. Cost-effectiveness of acu-puncture versus standard care for pelvic and low back pain in pregnancy:a randomized controlled trial[J]. PLoS One, 2019,14(4):e0214195. DOI URL
[37]	Bishop A, Holden MA, Ogollah RO, et al. Current management of pregnancy-related low back pain:a national cross-sectional survey of UK physiotherapists[J]. Physiotherapy, 2016,102(1):76.
[38]	Waterfield J, Bartlam B, Bishop A, et al. Physical therapists’ views and experiences of pregnancy-related low back pain and the role of acupuncture:qualitative exploration[J]. Phys Ther, 2015,95(9):1234-1243. DOI PMID
[39]	陈伟业, 王爱群, 张立贤. 韩氏穴位神经刺激仪对妊娠晚期下腰痛的影响[J]. 中国疼痛医学杂志, 2011,17(9):546-548.
	Chen WY, Wang AQ, Zhang LX. The effect of hans acupoint nerve timulator(hans)on the low back pain in late pregnancy[J]. Chin J Pain Med, 2011,17(9):546-548.
[40]	Sadeghi Aval Shahr H, Saadat M, Kheirkhah M, et al. The effect of self-aromatherapy massage of the abdomen on the primary dysmenorrhoea[J]. J Obstet Gynaecol, 2015,35(4):382-385. DOI PMID