中国人群使用卡贝缩宫素和缩宫素预防产后出血安全性的Meta-分析

目的 系统评价中国人群使用卡贝缩宫素和缩宫素用于预防产后出血的安全性。方法 计算机检索EMbase、PubMed，中国生物医学文献数据库（CBM）、中国学术期刊全文数据库（CNKI）、维普中文科技期刊数据库（VIP）和万方等数据库，收集卡贝缩宫素对比缩宫素用于预防中国人群产后出血安全性的随机对照研究（RCT），检索时限均从2000年1月—2017年12月。由2位研究者按事先设计好的纳入与排除标准筛选文献、提取资料、评价纳入研究的偏倚风险后，采用Rev Man 5.1软件进行Meta-分析。结果 共纳入12个RCTs，2 122例患者。Meta-分析结果显示，卡贝缩宫素的不良反应总发生率（OR=0.65，95%CI=0.48~0.88，P=0.005）显著小于缩宫素；不良反应临床类型亚组分析显示，卡贝缩宫素的恶心、呕吐发生率（OR=0.51，95%CI=0.35~0.74，P=0.000 4）、心动过速发生率（OR=0.20，95%CI=0.12~0.31，P<0.00001）和低血压发生率（OR=0.28，95%CI=0.13~0.60，P=0.001）均显著小于缩宫素；面部潮红发生率（OR=0.93，95%CI=0.363~1.36，P=0.70）和头痛、头晕发生率（OR=0.69，95%CI=0.43~1.08，P=0.11）均无显著性差异。结论 卡贝缩宫素能显著降低不良反应发生率，尤其在恶心、呕吐，心动过速和低血压方面尤为显著。

Safety of carbetocin and oxytocin for prevention of postpartum hemorrhage in Chinese patients by Meta-analysis

Objective To systemically evaluate the safety of carbetocin and oxytocin for prevention of postpartum hemorrhage in Chinese patients. Methods Search was conducted in the following databases:PubMed, EMbase, CNKI, VIP and WanFang Data from January 2000 to December 2017. Randomized controlled trials (RCTs) of the safety of caebetocin vs oxytocin in prevention of postpartum hemorrhage of cesarean section in Chinese patients were included. Two reviewers independently screened literatures, extracted data, and assessed the risk of bias of included studies according to the inclusion and exclusion criteria. Meta-analysis was conducted by RevMan 5.1 software. Results A total of 12 RCTs were included with 2 122 patients. Meta-analysis showed that:the total adverse reaction rate of carbetocin (OR=0.65, 95%CI=0.48-0.88, P=0.005) was much lower than that in oxytocin; And in clinical subgroups of adverse reaction, the rate of nausea or vomiting (OR=0.51, 95%CI=0.35-0.74, P=0.000 4), the rate of tachycardia (OR=0.20, 95%CI=0.12-0.31, P<0.000 01) and the rate of hypotension (OR=0.28, 95%CI=0.13-0.60, P=0.001) were all much lower than that in oxytocin; And the rate of facial flush (OR=0.93, 95%CI=0.363-1.36, P=0.70) and the rate of headache or dizziness (OR=0.69, 95%CI=0.43-1.08, P=0.11) had no significant difference than that in oxytocin. Conclusion The results of this study show that carbetocin can significantly reduce the adverse reaction rate, especially in nausea or vomiting, tachycardia and hypotension are particularly significant.