传统体表标志触诊与术前超声检查在产科椎管内麻醉中的对比研究：系统回顾与Meta分析

背景：这项系统回顾和meta分析的目的是与传统体表标志触诊法相比，比较术前超声检查对产科患者实施椎管内麻醉的有效性、所需时间和安全性。

方法：通过检索Central、CINAHL、EMBASE、Global Health、MEDLINE、Scopus和Web of Science等文献数据库，检索从建库最初到2020年2月13日的随机对照试验，纳入以传统体表标志触诊为对照、术前超声检查为干预措施的行椎管内镇痛麻醉的产妇。对于连续和二分结果，我们分别使用逆方差法计算平均差值，使用Mantel-Haenszel方法计算风险比。

结果：共纳入22项试验，2462名产妇。经试验序贯分析证实，在13个试验中，超声检查能够提高首次通过成功率，风险比(95%CI)为1.46(1.16~1.82)，p=0.001。在8项试验中，709名产妇的行术前超声检查和标志性触诊法的总时间未见差异，平均差异(95%CI)为50.1s(13.7s~113.94 s，p=0.12s)。对于这些共同的首要观察指标，证据质量分别被评定为低级和非常低级。亚组分析强调了采用术前超声检查对那些预测椎管内操作困难的产妇有明显优势。术前超声检查得以减少并发症，包括产后腰痛和头痛。

结论：作者建议在产科行椎管内麻醉中采用术前超声检查，鉴于其可能提高操作成功率和减少并发症，且不会显著延长所需时间，作者认为应该将其作为一种护理标准。

原始文献来源：B. Young, D. Onwochei and N. Desai. Conventional landmark palpation vs. Preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics–a systematic review and meta-analysis with trial sequential analyses.[J].Anaesthesia, 2020 Sep 27: doi:10.1111/anae.15255.

Conventional landmark palpation vs. Preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics–a systematic review and meta-analysis with trial sequential analyses

Abstract

The aim of this systematic review and meta-analysis was to examine the efficacy, time taken and the safety of neuraxial blockade performed for obstetric patients with the assistance of preprocedural ultrasound, in comparison with the landmark palpation method. The bibliographic databases Central, CINAHL, EMBASE, Global Health, MEDLINE, Scopus and Web of Science were searched from inception to 13 February 2020 for randomised controlled trials that included pregnant women having neuraxial procedures with preprocedural ultrasound as the intervention and conventional landmark palpation as the comparator. For continuous and dichotomous outcomes, respectively, we calculated the mean difference using the inverse-variance method and the risk ratio with the Mantel–Haenszel method. In all, 22 trials with 2462 patients were included. Confirmed by trial sequential analysis, preprocedural ultrasound increased thefirst-pass success rate by a risk ratio (95%CI) of 1.46 (1.16–1.82), p = 0.001 in 13 trials with 1253 patients. No evidence of a difference was found in the total time taken between preprocedural ultrasound and landmark palpation, with a mean difference (95%CI) of 50.1 (-13.7 to 113.94) s, p = 0.12 in eight trials with 709 patients. The quality of evidence was graded as low and very low, respectively, for these co-primary outcomes. Sub-group analysis underlined the increased benefit of preprocedural ultrasound for those in whom the neuraxial procedure was predicted to be difficult. Complications, including postpartum back pain and headache, were decreased with preprocedural ultrasound. The adoption of preprocedural ultrasound for neuraxial procedures in obstetrics is recommended and, in the opinion of the authors, should be considered as a standard of care, in view of its potential to increase efficacy and reduce complications without significant prolongation of the total time required.