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目的：通过证据图谱系统描述和评价不同干预措施纠正胎儿臀位的相关研究，为今后开展干预研究提供指导。方法：计算机检索2000年至2024年中国知网、万方数据、维普资讯、中国生物医学数据库、PubMed、Cochrane Library、Web of Science、EMBASE等数据库，获取胎儿臀位干预的随机对照试验和系统评价/Meta分析。采用Risk of Bias和AMSTAR-2对纳入的研究进行质量评价，基于护理结局分类系统对结局指标进行分类，对纳入的研究进行数据提取与编码，采用气泡图综合呈现纳入的研究内容。结果：最终纳入30篇文献，包括24篇随机对照试验和6篇系统评价/Meta分析，共涉及4种干预类型和12种干预方法。其中体位管理干预4篇，外倒转术18篇，分娩球运动1篇，艾灸/刺激至阴穴9篇。结局指标主要包括头位转化有效性28篇，分娩方式18篇、疼痛评分13篇，新生儿状况9篇、不良反应、并发症等；有22篇结局效果为有效或可能有效。结论：研究显示宫缩抑制剂或麻醉下行外倒转术对胎儿臀位的干预是有效、成功率高的，但不同麻醉方式存在差异性。针灸、艾灸与体位管理等方法的干预效果尚未得到确凿证据支持。未来可以将关注点放在新技术和大样本实证研究，并注重干预过程中孕妇的舒适度和心理状况。
Abstract：Objective:To systematically describe and evaluate evidence on interventions for correcting breech presentation through evidence mapping,providing guidance for future research and clinical practice.Methods:We searched databases including CNKI,Wanfang Data,VIP Information,CBM,PubMed,Cochrane Library,Web of Science,and EMBASE(2000-2024)for randomized controlled trials(RCTs)and systematic reviews/meta-analyses on breech presentation interventions. Study quality was assessed using the Cochrane Risk of Bias tool and AMSTAR-2.Outcome indicators were classified based on the Nursing Outcomes Classification(NOC),followed by data extraction,coding,and synthesis via bubble charts.Results:Thirty studies were included(24 RCTs and 6 systematic reviews/meta-analyses),covering 4 intervention categories and 12 specific methods:postural management(4 studies),external cephalic version(ECV)(18 studies),birthing ball exercises(1 study),and moxibustion/acupoint stimulation(9studies). Primary outcomes included cephalic presentation conversion rate(28 studies),delivery mode(18 studies),pain scores(13 studies),neonatal outcomes(9 studies),and adverse effects. Twenty-two studies reported interventions as effective or potentially effective.Conclusions:Current evidence supports the efficacy and high success rate of ECV performed under tocolysis or anesthesia,though outcomes vary by anesthetic approach. Acupuncture,moxibustion,and postural management lack conclusive evidence. Future research should focus on emerging technologies and large-scale empirical studies,while emphasizing maternal comfort and psychological well-being during interventions.
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基本信息:
中图分类号:R714.444
引用信息:
[1]谢舒淇,何倩庄,林岸芸,等.胎儿臀位干预方案的证据图谱分析[J].广州医科大学学报,2025,53(02):1-7.
基金信息:
广东省医学科学技术研究基金项目（B2022131）
2025-04-15
2025-04-15