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目的评价剖宫产术前应用碘伏进行阴道消毒预防术后感染的效果。方法利用计算机检索PubMed、EMBASE、中国生物医学文摘数据库(CBM)、中国知网期刊全文数据库(CNKI)、维普中文期刊全文数据库(CQVIP)中所有相关随机对照研究,按照标准对其筛选后进行质量评价,采用RevMan 5.2软件进行meta分析。结果纳入9个随机对照研究,共3 024例研究对象,其中术前阴道消毒产妇1 508例,对照组1 516例。分析结果表明,剖宫产术前应用碘伏进行阴道消毒能够降低术后子宫内膜炎发生率(RR=0.55,95%CI 0.36~0.85,P=0.007),对胎膜早破产妇(RR=0.29,95%CI 0.16~0.52,P<0.000 1)和临产产妇(RR=0.63,95%CI 0.41~0.96,P=0.03)子宫内膜炎发生率降低作用显著,而对胎膜未破产妇(RR=0.73,95%CI 0.50~1.08,P=0.11)和未临产产妇(RR=0.79,95%CI 0.53~1.17,P=0.24)的降低作用不显著。阴道消毒并不能降低术后切口感染率(RR=0.80,95%CI 0.53~1.22,P=0.30)和术后发热发生率(RR=0.92,95%CI0.76~1.11,P=0.37)。结论剖宫产术前给予阴道消毒能减少术后子宫内膜炎发生率,对胎膜早破产妇或临产产妇作用显著,但并不能降低术后切口感染率和发热率。
Objective To evaluate the efficacy of vaginal disinfection with iodophor before surgery to prevent postoperative infection. Methods All relevant randomized controlled trials of PubMed, EMBASE, CBM, CNKI and CQVIP were searched by computer, and their quality was screened according to the standard Evaluation, meta-analysis using RevMan 5.2 software. Results Nine RCTs were enrolled in the study. A total of 3 024 subjects were enrolled, of which 1 508 were preoperative vaginal disinfection and 1 516 in control group. The results showed that vaginal disinfection with iodophor before cesarean section could reduce the incidence of postoperative endometritis (RR = 0.55, 95% CI 0.36-0.85, P = 0.007) = 0.29, 95% CI 0.16 ~ 0.52, P <0.000 1), and the incidence of endometritis was significantly lower in the pregnant women (RR = 0.63,95% CI 0.41-0.96, P = 0.03) (RR = 0.73, 95% CI 0.50-1.08, P = 0.11) and non-pregnant women (RR = 0.79, 95% CI 0.53-1.17, P = 0.24). Vaginal disinfection did not reduce the rate of postoperative wound incision infection (RR = 0.80, 95% CI 0.53-1.22, P = 0.30) and incidence of postoperative fever (RR = 0.92, 95% CI 0.76-1.11, P = 0.37). Conclusion Intravaginal disinfection before cesarean delivery can reduce the incidence of postoperative endometritis, and has a significant effect on premature rupture of membranes or maternal mothers, but does not reduce the incision infection rate and fever rate.