Tocolytic therapy for preterm delivery: systematic review and network meta-analysis.
Tocolytic therapy for preterm delivery: systematic review and network meta-analysis.
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DOI：
10.1136/bmj.e6226
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发表时间：
2012-10-09
期刊：
影响因子：
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通讯作者：
Welton NJ
中科院分区：
文献类型：
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作者：
Haas DM;Caldwell DM;Kirkpatrick P;McIntosh JJ;Welton NJ
目的探讨延缓分娩最有效的解宫剂。设计系统综述和网络荟萃分析。数据来源：截至2012年2月17日的Cochrane对照试验中央登记、Medline、Medline in-Process、Embase和CINAHL。研究选择早产风险妇女宫缩治疗的随机对照试验。数据提取至少有两名评价者提取了有关研究设计、特征、参与者数量和报告的结果(新生儿和母亲)的数据。采用具有药物类别效应的随机效应模型进行网络Meta分析。对主要结局进行了两项敏感性分析；局限于低偏倚风险的研究和排除早产高风险妇女(多胎妊娠和胎膜破裂的妇女)的研究。结果在最初确定的3263篇文章中，95篇关于宫缩治疗的随机对照试验被综述。与安慰剂相比，前列腺素抑制剂延迟分娩48小时的概率最高(优势比5.39，95%可信区间2.14至12.34)，其次是硫酸镁(2.76，1.58至4.94)，钙通道阻滞剂(2.71，1.17至5.91)，β模拟药物(2.41，1.27至4.55)，以及催产素受体阻滞剂妥西班(2.02，1.10至3.80)。在减少新生儿呼吸窘迫综合征方面，没有一种产后裂解明显优于安慰剂。与安慰剂相比，需要更换药物的副作用显著高于β-模拟药物(22.68，7.51至73.67)、硫酸镁(8.15，2.47至27.70)和钙通道阻滞剂(3.80，1.02至16.92)。前列腺素抑制剂和钙通道阻滞剂是最有可能在分娩延迟48小时、呼吸窘迫综合征、新生儿死亡率和母亲副作用(所有原因)的结果方面排名前三的药物类别。结论前列腺素抑制剂和钙通道阻滞剂延迟分娩、改善新生儿和产妇结局的概率最高。
Objective To determine the most effective tocolytic agent at delaying delivery. Design Systematic review and network meta-analysis. Data sources Cochrane Central Register of Controlled Trials, Medline, Medline In-Process, Embase, and CINAHL up to 17 February 2012. Study selection Randomised controlled trials of tocolytic therapy in women at risk of preterm delivery. Data extraction At least two reviewers extracted data on study design, characteristics, number of participants, and outcomes reported (neonatal and maternal). A network meta-analysis was done using a random effects model with drug class effect. Two sensitivity analyses were carried out for the primary outcome; restricted to studies at low risk of bias and restricted to studies excluding women at high risk of preterm delivery (those with multiple gestation and ruptured membranes). Results Of the 3263 titles initially identified, 95 randomized controlled trials of tocolytic therapy were reviewed. Compared with placebo, the probability of delivery being delayed by 48 hours was highest with prostaglandin inhibitors (odds ratio 5.39, 95% credible interval 2.14 to 12.34) followed by magnesium sulfate (2.76, 1.58 to 4.94), calcium channel blockers (2.71, 1.17 to 5.91), beta mimetics (2.41, 1.27 to 4.55), and the oxytocin receptor blocker atosiban (2.02, 1.10 to 3.80). No class of tocolytic was significantly superior to placebo in reducing neonatal respiratory distress syndrome. Compared with placebo, side effects requiring a change of medication were significantly higher for beta mimetics (22.68, 7.51 to 73.67), magnesium sulfate (8.15, 2.47 to 27.70), and calcium channel blockers (3.80, 1.02 to 16.92). Prostaglandin inhibitors and calcium channel blockers were the tocolytics with the best probability of being ranked in the top three medication classes for the outcomes of 48 hour delay in delivery, respiratory distress syndrome, neonatal mortality, and maternal side effects (all cause). Conclusions Prostaglandin inhibitors and calcium channel blockers had the highest probability of delaying delivery and improving neonatal and maternal outcomes.