目的:本研究旨在确定针对体重指数≥40kg/m2的人群的循证围产期干预措施。
方法:PubMed,MEDLINE,EMBASE,科克伦,CINAHL,和ClinicalTrials.gov从成立到2022年没有日期进行搜索,出版物类型,或语言限制。
方法:纳入了对体重指数≥40kg/m2的人实施干预并评估围产期结局的队列和随机对照试验。主要结局取决于干预措施,但通常与剖宫产后的伤口发病率有关(即,感染,分离,血肿)。
方法:对至少2项研究的干预措施进行了Meta分析。报告了具有95%置信区间和异质性(I2统计)的集合风险比。
结果:在筛选的20,301项研究中,包括30项研究(17项队列和13项随机对照试验),包括10种干预措施。干预措施包括分娩计划(引产,计划剖宫产),引产期间或用于手术预防的抗生素,6种剖宫产技术,剖宫产后的抗凝剂量。根据3项队列研究,与计划的阴道分娩相比,计划的剖宫产并没有改善结局。一项队列研究比较了3g和2g头孢唑林预防剖宫产的效果,发现手术部位感染没有差异。根据3项队列研究和2项随机对照试验,非下横切皮肤切口的结局无改善.10项研究(4项队列和6项随机对照试验)符合荟萃分析的纳入标准。两项随机对照试验比较了剖宫产后缝合下表皮下封闭与缝合钉的差异,发现剖宫产后6周内伤口发病率无差异(n=422;风险比,1.09;95%置信区间,0.75-1.59;I2=9%)。在4个队列和4个随机对照试验中,预防性负压伤口治疗与标准敷料进行了比较。发现伤口发病率没有差异(队列n=2200;风险比,1.19;95%置信区间,0.88-1.63;I2=66.1%)或手术部位感染(随机对照试验n=1262;风险比,0.90;95%置信区间,0.63-1.29;I2=0)。
结论:很少有研究针对体重指数≥40kg/m2的人进行干预,大多数研究没有显示出益处。缝合钉或缝合被推荐用于表皮下闭合,但现有数据不支持对体重指数≥40kg/m2的患者进行剖宫产术后预防性负压伤口治疗.
OBJECTIVE: This study aimed to identify evidence-based peripartum interventions for people with a body mass index ≥40 kg/m2.
METHODS: PubMed, MEDLINE, EMBASE, Cochrane, CINAHL, and ClinicalTrials.gov were searched from inception to 2022 without date, publication type, or language restrictions.
METHODS: Cohort and randomized controlled trials that implemented an intervention and evaluated peripartum outcomes of people with a body mass index ≥40 kg/m2 were included. The primary outcome depended on the intervention but was commonly related to wound morbidity after cesarean delivery (ie, infection, separation, hematoma).
METHODS: Meta-analysis was completed for interventions with at least 2 studies. Pooled risk ratios with 95% confidence intervals and heterogeneity (I2 statistics) were reported.
RESULTS: Of 20,301 studies screened, 30 studies (17 cohort and 13 randomized controlled trials) encompassing 10 types of interventions were included. The interventions included delivery planning (induction of labor, planned cesarean delivery), antibiotics during labor induction or for surgical prophylaxis, 6 types of cesarean delivery techniques, and anticoagulation dosing after a cesarean delivery. Planned cesarean delivery compared with planned vaginal delivery did not improve outcomes according to 3 cohort studies. One cohort study compared 3 g with 2 g of cephazolin prophylaxis for cesarean delivery and found no differences in surgical site infections. According to 3 cohort studies and 2 randomized controlled trials, there was no improvement in outcomes with a non-low transverse skin incision. Ten studies (4 cohort and 6 randomized controlled trials) met the inclusion criteria for the meta-analysis. Two randomized controlled trials compared subcuticular closure with suture vs staples after cesarean delivery and found no differences in wound morbidity within 6 weeks of cesarean delivery (n=422; risk ratio, 1.09; 95% confidence interval, 0.75-1.59; I2=9%). Prophylactic negative-pressure wound therapy was compared with standard dressing in 4 cohort and 4 randomized controlled trials, which found no differences in wound morbidity (cohort n=2200; risk ratio, 1.19; 95% confidence interval, 0.88-1.63; I2=66.1%) or surgical site infections (randomized controlled trial n=1262; risk ratio, 0.90; 95% confidence interval, 0.63-1.29; I2=0).
CONCLUSIONS: Few studies address interventions in people with a body mass index ≥40 kg/m2, and most studies did not demonstrate a benefit. Either staples or suture are recommended for subcuticular closure, but available data do not support prophylactic negative-pressure wound therapy after cesarean delivery for people with a body mass index ≥40 kg/m2.