Nifedipine versus ritodrine for suppression of preterm labor; a meta‐analysis
Nifedipine versus ritodrine for suppression of preterm labor; a meta‐analysis
复制标题
硝苯地平与利托君抑制早产的荟萃分析；
DOI：
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发表时间：
1999
影响因子：
4.3
通讯作者：
H. Brölmann
中科院分区：
文献类型：
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作者：
S. Oei;B. Mol;M. D. de Kleine;H. Brölmann
背景
由于缺乏比较硝苯地平和利托君抑制早产有效性的大型随机临床试验，我们对该主题进行了荟萃分析。
方法
我们使用关键词“硝苯地平”、“利托君”和“随机化”或“随机化”检索数据库Medline和EMBASE。对研究的盲法、随机化方法和分析类型（“意向治疗”与“符合方案”）进行评分。随后，以“分娩延迟48小时或更长时间”、“分娩延迟超过妊娠36周”、围产期死亡率、呼吸窘迫综合征和新生儿重症监护室入院作为终点，构建了两个两个的表格。采用Breslow-Day检验检验研究间的均匀性。如果不能拒绝同质性，则计算合并比值比。
结果
我们可以检测到1986年至1998年间发表的10项研究，纳入了681例患者的数据。与利托君相比，硝苯地平降低了48小时内分娩的风险，但这种差异没有统计学意义（比值比0.85，95%置信区间0.54至1.1）。与利托君相比，硝苯地平也降低了36周前分娩的风险，这种差异具有统计学意义（比值比0.59，95%置信区间0.39至0.90）。我们不了解报告长期结局的研究。
结论
由于缺乏长期结果的研究报告，硝苯地平和利托君之间的选择只能基于产科和短期新生儿的结果。从这个角度来看，硝苯地平应该是抑制早产的首选药物。
BACKGROUND
Since large randomized clinical trials comparing the effectiveness of nifedipine and ritodrine in the suppression of preterm labor are lacking, we performed a meta-analysis on the subject.
METHODS
We searched the databases Medline and EMBASE using the keywords 'nifedipine', 'ritodrine' and 'randomized' or 'randomised'. The studies were scored for blinding, method of randomization and type of analysis ('intention-to-treat' versus 'par protocol'). Subsequently, two by two tables were constructed using 'delay of labor by 48 hours or more', 'delay of labor beyond 36 weeks gestation', perinatal mortality, respiratory distress syndrome and admission to a neonatal intensive care unit as end points. Homogeneity between the studies was tested with a Breslow-Day test. Pooled odds ratios were calculated in case homogeneity could not be rejected.
RESULTS
We could detect ten studies that were published between 1986 and 1998, incorporating data of 681 patients. Nifedipine reduced the risk of delivery within 48 hours compared to ritodrine, but this difference was not statistically significant (odds ratio 0.85, 95% confidence interval 0.54 to 1.1). Nifedipine also reduced the risk of delivery before 36 weeks compared to ritodrine, and this difference was statistically significant (odds ratio 0.59, 95% confidence interval 0.39 to 0.90). We are not aware of studies reporting on long-term outcome.
CONCLUSION
Since studies reporting on long-term outcome are lacking, the choice between nifedipine and ritodrine can only be based on obstetrical and short-term neonatal outcomes. From that perspective, nifedipine should be the drug of first choice for the suppression of preterm labor.