硫酸镁预防剖宫产术产妇寒战的meta分析

尚勇 李帆 胡振飞 邹田田

[摘要] 目的 評估硫酸镁预防剖宫产术产妇寒战的临床应用效果。 方法 计算机检索PubMed、The Cochrane Library（2019年第8期）、EMbase、万方数据知识服务平台（WanFang Data）、中国知网（CNKI）、中国生物医学文献数据库（CBM），查找有关硫酸镁对实施剖宫产术的产妇寒战影响的随机对照试验（RCT），检索时限为建库—2019年8月。根据所纳入RCT参考文献的相关文献进行追溯。采用RevMan 5.3软件进行meta分析，GRADE证据质量评价评估meta分析结果的证据等级。 结果 最终纳入15篇文献，1043例患者，使用硫酸镁患者532例。meta分析结果显示：试验组产妇寒战发生率低于对照组（RR = 0.48，95%CI：0.37～0.63，P < 0.000 01）。静脉注射亚组产妇寒战发生率低于对照组（RR = 0.46，95%CI：0.33～0.66，P < 0.0001）;蛛网膜下腔注射亚组产妇寒战发生率与对照组比较，差异无统计学意义（P = 0.12）;硬膜外注射亚组产妇寒战发生率低于对照组（RR = 0.38，95%CI：0.21～0.67，P = 0.0009）。蛛网膜下腔麻醉亚组产妇寒战发生率低于对照组（RR = 0.53，95%CI：0.36～0.78，P = 0.001）;腰硬联合麻醉亚组产妇寒战发生率低于对照组（RR = 0.45，95%CI：0.29～0.68，P = 0.0002）。不同给药方式亚组meta分析结果质量等级均为“Moderate”。 结论 静脉注射、硬膜外注射硫酸镁能够预防行剖宫产术产妇寒战的发生，但蛛网膜下腔注射硫酸镁预防行剖宫产术产妇寒战的效果尚待评估。

[关键词] 硫酸镁;剖宫产术;寒战;meta分析

[中图分类号] R714.3          [文献标识码] A          [文章编号] 1673-7210（2020）07（c）-0103-06

Meta-analysis of Magnesium Sulfate to prevent shivering during cesarean section

SHANG Yong   LI Fan   HU Zhenfei   ZOU Tiantian

Department of Anesthesiology， the First Affiliated Hospital of Xinjiang Medical University， Xinjiang Uygur Autonomous Region， Urumqi   830054， China

[Abstract] Objective To evaluate the effect of Magnesium Sulfate to prevent shivering during cesarean section. Methods Databases including PubMed， The Cochrane Library （Issue 8， 2019）， EMbase， Wanfang Data Knowledge Service Platform （WanFang Data）， China National Knowledge Infrastructure （CNKI）， China Biology Medicine disc （CBM） were searched for computer to collect the randomized controlled trails （RCT） about the effect of Magnesium Sulfate on shivering for cesarean section. The retrieval time limit from repository to August 2019. The literature was tracked based on the references included in the RCT. Meta-analysis was conducted using RevMan 5.3 software， GRADE of evidence quality was used to evaluate the evidence level of meta-analysis results. Results Finally， 15 references were included， including 1043 patients and 532 patients with Magnesium Sulfate. The results of meta-analysis showed that： the incidence of shivering in experimental group was lower than that in control group （RR = 0.48， 95%CI：0.37-0.63， P < 0.000 01）. The incidence of shivering in intravenous subgroup was lower than that in control group （RR = 0.46， 95%CI：0.33-0.66， P < 0.0001）; the incidence of shivering in subarachnoid injection subgroup had no statistically significant difference compared with control group （P = 0.12）; the incidence of shivering in epidural injection subgroup was lower than that in control group （RR = 0.38， 95%CI：0.21-0.67， P = 0.0009）. The incidence of shivering in subarachnoid anesthesia subgroup was lower than that in control group （RR = 0.53， 95%CI： 0.36-0.78， P = 0.001）; the incidence of shivering in combined lumbar and epidural anesthesia subgroup was lower than that in control group （RR = 0.45， 95%CI： 0.29-0.68， P = 0.0002）. Meta-analysis results for different administration subgroups were all evaluated as “Moderate”. Conclusion Intravenous injection and epidural injection of Magnesium Sulfate can prevent shivering in cesarean section， but the effect of subarachnoid injection of Magnesium Sulfate to prevent the occurrence of shivering in cesarean section remains to be evaluated.

蛛網膜下腔麻醉是剖宫产术常用的麻醉方式，具有起效快、麻醉效果确切等诸多优点。硫酸镁具有抑制子宫收缩、治疗胎儿宫内窘迫的作用。本研究中有6篇[9，11，13，15-17]经蛛网膜下腔注射硫酸镁，但亚组分析结果却显示，硫酸镁蛛网膜下腔注射亚组产妇寒战发生率与对照组比较，差异无统计学意义（P = 0.12），在预防剖宫产术寒战方面并未体现出明显优势。在3种给药方式中，静脉注射硫酸镁能够使药物快速发挥其药理作用。研究显示[8，17]，蛛网膜下腔注射、硬膜外注射硫酸镁具有较高安全性。与蛛网膜下腔注射比较，硬膜外注射后，药物沿硬膜外间隙上下扩散，在此过程中部分药物经毛细血管吸收入血而发挥作用，但蛛网膜下腔注射给药并无上述过程[24]。因此，蛛网膜下腔注射与硬膜外注射的上述区别可能是导致蛛网膜下腔注射硫酸镁在预防寒战方面效果不佳的原因。

本研究共纳入15篇[7-21]RCT，其中7篇[8，11-12，14-15，17-18]采用分配隐藏，纳入研究整体质量尚可但仍存在局限性。首先，所纳入部分研究未报告研究对象年龄、各研究间硫酸镁用药剂量不同，可能影响本研究结果的可靠性;其次，15篇[7-21]RCT均为小样本量，所得结论仍需进一步加以明确;最后，硫酸镁不同给药方式的亚组meta分析结果质量等级均为“Moderate（中）”，故所得结论仍需更多高质量RCT加以验证。

综上所述，静脉注射、硬膜外注射硫酸镁能够预防行剖宫产术产妇寒战的发生，但蛛网膜下腔注射硫酸镁预防行剖宫产术产妇寒战的效果尚待评估。

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（收稿日期：2019-12-06）