背景:分娩疼痛是女性的常见经历,对母亲和新生儿都有风险。身心干预在不同的环境中表现出了有效性,但它们在分娩疼痛管理中的有效性仍存在争议。
目的:确定各类身心干预措施对分娩疼痛管理的影响,特别是疼痛强度;药物止痛药的使用;以及随之而来的结果,包括剖腹产率,劳动时间,对分娩的恐惧。
方法:系统评价和荟萃分析。
方法:在10个数据库中进行了相关文章的系统检索。纳入了随机对照试验,重点研究了身心干预在分娩疼痛管理中的有效性。两名研究人员独立进行了方法学质量评估,数据提取和证据分级。当研究测量相同的结果时,进行荟萃分析。计算了连续变量的标准化平均差,同时计算二分变量的风险比。所有分析均使用RevMan版本5.3进行。
结果:共纳入24项试验的25项研究,和六类身心干预,即催眠,正念,呼吸技巧,肌肉放松技术,引导图像,和治疗触觉,已确定。具体来说,催眠和正念可能有效缓解分娩疼痛强度,具有较大的效应大小(SMD:-1.45,95%置信区间[CI]-2.34,-0.55,I2=91%;SMD:-1.22,95%CI-2.07,-0.37,I2=93%,分别),但不能减少硬膜外镇痛的使用。正念,特别是,剖腹产率在统计学上显着降低,效应大小较小(RR:0.46,95%CI0.21,0.97,I2=49%),害怕分娩,具有中等效应大小(SMD:-0.63,95%CI-1.09,-0.17,I2=65%)。此外,与对照条件相比,所有类型的身心干预均与产程时间显著缩短相关.
结论:身心干预在降低分娩疼痛强度方面可能有潜在的益处,剖腹产率,劳动的持续时间,和对分娩的恐惧,从小到大的效果大小。特别是,催眠和正念在缓解分娩疼痛强度方面表现出显着的积极作用,具有较大的效果尺寸。这些干预措施可以作为临床实践中分娩疼痛管理的补充或替代方法。然而,我们需要进一步严格的随机对照试验来证实我们的结果.
背景:CRD42024498600(PROSPERO,2024年1月15日)。
BACKGROUND: Labour pain is a common experience among women and poses risks to both the mother and neonate. Mind-body interventions have demonstrated effectiveness in diverse contexts, but their effectiveness in labour pain management remains controversial.
OBJECTIVE: To identify the effects of each category of mind-body interventions on labour pain management, particularly pain intensity; the use of pharmacological pain relief medications; and the consequent outcomes, including the rate of caesarean section, duration of labour, and fear of childbirth.
METHODS: Systematic review and meta-analysis.
METHODS: A systematic search for related articles was conducted in 10 databases. Randomised controlled trials focusing on the effectiveness of mind-body interventions in labour pain management were included. Two researchers independently conducted methodological quality assessments, data extraction and grading the evidence. Meta-analyses were conducted when studies measured the same outcomes. Standardised mean differences were calculated for continuous variables, whilst risk ratios were calculated for dichotomous variables. All analyses were performed using RevMan version 5.3.
RESULTS: A total of 25 studies from 24 trials were included, and six categories of mind-body interventions, namely
hypnosis, mindfulness, breathing skills, muscle relaxation techniques, guided imagery, and therapeutic touch, were identified. Specifically,
hypnosis and mindfulness might be effective in relieving labour pain intensity, with large effect sizes (SMD: -1.45, 95 % confidence interval [CI] -2.34, -0.55, I2 = 91 %; SMD: -1.22, 95 % CI -2.07, -0.37, I2 = 93 %, respectively), but could not reduce the use of epidural analgesia. Mindfulness, in particular, yielded statistically significant reductions in the rate of caesarean section, with a small effect size (RR: 0.46, 95 % CI 0.21, 0.97, I2 = 49 %), and in fear of childbirth, with a medium effect size (SMD: -0.63, 95 % CI -1.09, -0.17, I2 = 65 %). Additionally, all categories of mind-body interventions were associated with a significantly decreased duration of labour compared with the control conditions.
CONCLUSIONS: Mind-body interventions may have potential benefits in terms of decreasing labour pain intensity, the rate of caesarean section, the duration of labour, and fear of childbirth, with small-to-large effect sizes. Particularly,
hypnosis and mindfulness exhibited significant positive effects in terms of relieving labour pain intensity, with large effect sizes. These interventions could serve as complementary or alternative methods for labour pain management in clinical practice. Nevertheless, further rigorous randomised controlled trials are warranted to confirm our results.
BACKGROUND: CRD42024498600 (PROSPERO, January 15, 2024).