择期剖宫产围术期不留置尿管有效性和安全性的Meta分析被引量：6

Efficacy and safety of non-indwelling urinary catheter during perioperative period of cesarean section:a Meta-analysis

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摘要目的系统评价择期剖宫产围术期不留置尿管的有效性和安全性。方法计算机检索Medline(PubMed)、EMbase、The Cochrane Library、OVID、中国知网、万方数据知识服务平台,全面搜集有关择期剖宫产围术期不留置尿管有效性和安全性的随机对照试验(RCT)。由2位研究者独立完成文献筛选,资料提取和质量评价,采用RevMan5.3软件进行Meta分析。结果最终纳入5个RCTs,共1 090例患者。Meta分析结果显示,与留置尿管组相比,不留置尿管组虽然增加了尿潴留发生率[RR=11.67,95%CI(2.22,61.24),P<0.01],但是明显降低了UTI发生率[RR=0.10,95%CI(0.04,0.26),P<0.01]和初次排尿不适感发生率[RR=0.17,95%CI(0.04,0.74),P=0.02],明显缩短了首次下床活动时间[SMD=-3.68,95%CI(-5.25,-2.12),P<0.01]和住院时间[SMD=-1.03,95%CI(-1.67,-0.38),P<0.01],两组手术时间[SMD=-0.13,95%CI(-0.32,0.07),P=0.20]和产后出血发生率[RR=1.50,95%CI(0.43,5.26),P=0.53]比较差异无统计学意义,膀胱损伤的发生率相似。结论基于目前临床研究证据,择期剖宫产围术期不留置尿管是有效、安全的,提示剖宫产围术期留置尿管应为选择性而不是常规留置。 Objective To systematically assess the efficacy and safety of non-indwelling urinary catheter during perioperative period of cesarean section.Methods The databases including Medline（PubMed）,EMbase,Cochrane Library,CNKI and WanFang Data were retrieved by computer.The randomized controlled trials（RCTs）on the efficacy and safety of non-indwelling urinary catheter during perioperative period of cesarean section were comprehensively collected.Two reviewers independently screened literatures,extracted the data and assessed the quality.The Meta-analysis was conducted by using RevMan 5.3software.Results A total of 5RCTs involving 1 090 patients were included.The meta-analysis results showed that compared with the indwelling urinary catheter group,although the non-indwelling urinary catheter group increased the incidence rate of urinary retention[RR=11.67,95%CI（2.22,61.24）,P0.01],but significantly decreased the incidence rate of urinary tract infection（UTI）[RR=0.10,95%CI（0.04,0.26）,P0.01]and incidence rate of initial urination discomfort[RR=0.17,95%CI（0.04,0.74）,P=0.02],significantly shortened the initial time of off-bed activities [SMD=-3.68,95%CI（-5.25,-2.12）,P0.01]and hospitalization time[SMD=-1.03,95%CI（-1.67,-0.38）,P0.01].There were no significant differences in the operation time[SMD=-0.13,95%CI（-0.32,0.07）,P=0.20]and incidence rate of postpartum hemorrhage（PPH）[RR=1.50,95%CI（0.43,5.26）,P=0.53],The incidence rates of bladder injury in the two groups were similar.Conclusion According to the evidence of current clinical researches,selecting non-indwelling urinary catheter in elective cesarean section is effective and safe,prompting that indwelling urinary catheter during the perioperative period of cesarean section is selective rather than routine indwelling.