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目的系统评价卡前列素氨丁三醇治疗产后出血的有效性和安全性。方法检索PubMed、Cochrane Library、EMbase数据库和中国知网、维普和万方数据库,收集卡前列素氨丁三醇(试验组)和缩宫素(对照组)治疗产后出血的随机对照试验(RCT)。提取年龄、用药方案、产后出血量和药物不良反应等数据并评价质量后,用RevMan 5.0软件进行统计分析。结果共纳入25项RCT,合计4503例患者(试验组2266例,对照组2237例)。Meta分析结果显示,术中出血量、产后2 h出血量、产后24 h出血量的均数差分别为=-75.62,-105.50,-116.89,试验组的出血量显著低于对照组,差异均有统计学意义(均P<0.001);产后血红蛋白下降值的均数差-2.07,对照组的产后血红蛋白下降值显著低于试验组,差异有统计学意义(P<0.001)。治疗后,试验组和对照组的出血发生率分别为8.94%(164/1834例)和18.38%(334/1817例),恶心呕吐发生率分别为13.73%(171/1245例)和8.70%(108/1241例),差异均有统计学意义(均P<0.001)。结论卡前列素氨丁三醇治疗产后出血的效果明显优于缩宫素,且能减少出血发生率,但会增加恶心呕吐发生率。
Objective To systematically evaluate the efficacy and safety of carboprost trometamol in the treatment of postpartum hemorrhage. Methods PubMed, Cochrane Library, EMbase database, CNKI, VIP and Wanfang databases were searched. Randomized controlled trials (RCTs) were performed for the treatment of postpartum hemorrhage with carduvastatin (experimental group) and oxytocin (control group) . The data of age, drug regimen, postpartum hemorrhage and adverse drug reactions were extracted and evaluated. RevMan 5.0 software was used for statistical analysis. Results A total of 25 RCTs were included, with a total of 4503 patients (2266 in the experimental group and 2237 in the control group). The results of Meta analysis showed that the mean intraoperative blood loss, the amount of blood loss at 2 h postpartum and the amount of hemorrhage at 24 h postpartum were -75.62, -105.50 and -116.89, respectively. The bleeding volume in the experimental group was significantly lower than that in the control group (P <0.001). The mean difference of postpartum hemoglobin value was -2.07. The postpartum hemoglobin value of control group was significantly lower than that of the experimental group (P <0.001). After treatment, the incidences of bleeding in the experimental and control groups were 8.94% (164/1834) and 18.38% (334/1817), respectively. The incidences of nausea and vomiting were 13.73% (171/1245) and 8.70% 108/1241 cases), the differences were statistically significant (all P <0.001). Conclusions Carprost trometamol is superior to oxytocin in the treatment of postpartum hemorrhage, and can reduce the incidence of hemorrhage, but can increase the incidence of nausea and vomiting.