背景:关于分娩期间静脉(IV)液体给药的类型和速率的证据仍然没有定论,评估IV液体影响的研究结果好坏参半。
目的:评估静脉输液速率为250mL/h与125mL/h相比对未分娩妇女分娩结局的影响。
方法:我们通过包含相关关键词“IV水合”的搜索策略,搜索了六个数据库中的相关研究,“静脉注射液”,和“劳工”从这些数据库开始到2023年5月1日,没有任何应用限制。
方法:将搜索结果导入Covidence,以筛选本综述的合格文章。仅包括随机对照试验(RCT),评估250mL/h的静脉输液对足月(>37周)未产妇女分娩结局的影响,与125mL/h相比。
方法:有关纳入研究特征的数据,参与者的基线特征,在Excel电子表格中收集相关结局,并将所有相关结局汇总为风险比(RR)或均差(MD),在使用RevMan5.4的荟萃分析模型中使用95%置信区间(CI).
结果:来自11个RCT的1815例患者的汇总数据显示,250mL/h的输液速度显着降低了剖宫产率(RR0.70,95%CI0.56-0.88,P=0.002),第一产程持续时间(MD-46.97,95%CI-81.79至-12.14,P=0.008),第二产程持续时间(MD-2.69,95%CI-4.34至-1.05,P=0.001),延长分娩发生率(RR0.72,95%CI0.58-0.89,P=0.003),与125mL/h相比。此外,阴道分娩率(RR1.07,95%CI1.02-1.12,P=0.009)较高,输注速率为250mL/h.
结论:在未产妇分娩期间以250mL/h的速度输注静脉输液降低了剖宫产率,增加了阴道分娩率,缩短了第一和第二阶段的分娩时间,与125mL/h相比,延长分娩的发生率降低。这些发现表明,随着输液率的提高,产程进展加快,产程并发症的风险降低。然而,未来的研究涉及更多样化的人群,并探索将静脉输液速率与其他干预措施相结合的潜在益处,例如在分娩期间添加葡萄糖或较少限制的口服摄入,是需要的。
BACKGROUND: Evidence regarding the type and rate of intravenous (IV) fluid administration during labor is still inconclusive and the studies assessing the impact of IV fluids had mixed results.
OBJECTIVE: To evaluate the effects of IV fluids at an infusion rate of 250 mL/h as compared with 125 mL/h on labor outcomes in nulliparous women.
METHODS: We searched six databases for relevant studies through a search strategy containing the relevant keywords \"IV hydration\", \"IV fluids\", and \"labor\" from the inception of these databases to May 1, 2023, without any applied restrictions.
METHODS: Search results were imported to Covidence for screening of eligible articles for this
review. Randomized controlled trials (RCTs) assessing the impact of IV fluids at 250 mL/h on the outcomes of labor in nulliparous women at term (>37 weeks) as compared with 125 mL/h were included only.
METHODS: Data regarding the characteristics of included studies, participant\'s baseline characteristics, and concerned outcomes were collected in an Excel spreadsheet and all the concerned outcomes were pooled as risk ratios (RR) or mean difference (MD) with 95% confidence interval (CI) in the meta-analysis models using RevMan 5.4.
RESULTS: Pooled data from 11 RCTs with 1815 patients showed that 250 mL/h infusion rate had a significant reduction in cesarean section rate (RR 0.70, 95% CI 0.56-0.88, P = 0.002), the first stage of labor duration (MD -46.97, 95% CI -81.79 to -12.14, P = 0.008), the second stage of labor duration (MD -2.69, 95% CI -4.34 to -1.05, P = 0.001), prolonged labor incidence (RR 0.72, 95% CI 0.58-0.89, P = 0.003), as compared with 125 mL/h. Also, the vaginal delivery rate (RR 1.07, 95% CI 1.02-1.12, P = 0.009) was higher with a 250 mL/h infusion rate.
CONCLUSIONS: IV fluids at an infusion rate of 250 mL/h during labor in nulliparous women decreased the cesarean delivery rate, increased the vaginal delivery rate, shortened the first and second-stage labor duration, decreased the incidence of prolonged labor as compared with 125 mL/h. These findings suggest enhanced labor progression and a lower risk of labor complications with higher infusion rates. However, future research involving a more diverse population and exploring the potential benefits of combining IV infusion rates with other interventions, such as adding dextrose or less restrictive oral intake during labor, is needed.