2020 年第 9 期 第 15 卷

蛛网膜下腔-硬膜外联合麻醉与蛛网膜下腔阻滞在剖宫产术中临床疗效比较的Meta分析

Comparison of clinical efficacy between combined subarachnoid-epidural anesthesia and subarachnoid block in caesarean section: a Meta-analysis

作者：支晓雁1薛小云1田毅1董盛龙1马骏2李岩2

英文作者：Zhi Xiaoyan1 Xue Xiaoyun1 Tian Yi1 Dong Shenglong1 Ma Jun2 Li Yan2

单位：1海口市人民医院中南大学湘雅医学院附属海口医院麻醉与疼痛医学科570208；2首都医科大学附属北京安贞医院麻醉中心100029

英文单位：1Department of Anesthesiology and Pain Medicine Haikou People′s Hospital Central South University Xiangya School of Medical Affiliated Haikou Hospital Haikou 570208 China; 2Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：剖宫产手术；蛛网膜下腔-硬膜外联合麻醉；硬膜外麻醉

英文关键词：Caesareansection;Subarachnoid-epiduralanesthesia;Epiduralanaesthesia

• 摘要：

• 目的 比较蛛网膜下腔-硬膜外联合麻醉（腰硬联合麻醉）与蛛网膜下腔阻滞（腰麻）在剖宫产术中的疗效和安全性。方法 计算机检索Pubmed、Cochrane图书馆、Embase、中国知网、万方数据库及中国生物医学文献数据库，均从建库开始到2018年3月，查找腰硬联合麻醉与腰麻在剖宫产手术中临床疗效比较的随机对照研究，采用STATA 12.0软件进行Meta分析。结果 共纳入随机对照试验11项，涉及剖宫产产妇817例，其中接受腰硬联合麻醉者（观察组）403例，接受腰麻者（对照组）414例。Meta分析结果显示，2组最高感觉阻滞平面高度和血管升压药物使用量差异均无统计学意义（均P＞0.05）。观察组恶心（比值比=0.47,95%置信区间：0.25～0.90,P=0.022）、低血压（比值比=0.49,95%置信区间：0.31～0.75,P=0.001）发生率及总不良反应发生率（比值比=0.57,95%置信区间：0.42～0.79,P=0.001）均低于对照组，差异均有统计学意义。结论 剖宫产手术中选择腰硬联合麻醉可以降低恶心和低血压的发生率，并且可以达到与腰麻相当的临床疗效。

• Objective To compare the efficacy and safety of subarachnoid-epidural anesthesia and subarachnoid anesthesia in cesarean section. Methods The clinical data of combined lumbar hard anesthesia and lumbar anesthesia in cesarean section were searched in Pubmed, Cochrane Library, Embase, CNKI, Wanfang database and CBM. Meta-analysis was performed by using STATA 12.0 software. Results A total of 11 random controlled trials involving 817 patients were included. There were 403 patients (observation group) receiving combined subarachnoid-epidural anesthesia; 414 patients received spinal anesthesia (control group). There were no significant differences in maximum sensory block height and vasopressor dose between the two groups (both P＞0.05). The incidences of overall adverse reaction［odds ratio(OR)=0.57, 95% confidence interval(CI): 0.42-0.79, P=0.001］, nausea(OR=0.47, 95%CI: 0.25-0.90, P=0.022) and hypotension(OR=0.49, 95%CI: 0.31-0.75, P=0.001) in observation group were lower than those in control group. Conclusion In cesarean section, combined subarachnoid-epidural anesthesia can reduce the incidence of nausea and hypotension.