Page 109 - 中国全科医学2022-15

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the probability of natural childbirth published between 1990 and 2021 were searched in databases of CNKI，SinoMed，CQVIP，
PubMed，EMBase，Web of Science，and Cochrane Library. Meanwhile，the references of systematic reviews on relevant RCTs
were also searched and reviewed. Data extraction and methodological quality assessment were conducted for the included studies.
RevMan 5.2 was used for meta-analysis. GRADE was used to rate the quality of evidence concerning an outcome. Results A total
of 30 studies with 3 910 subjects were included. Meta-analysis found that physical exercise interventions were superior to routine
care in improving the natural childbirth rate〔RR=1.34，95%CI（1.28，1.40），P<0.000 01〕. Subgroup analyses revealed
that natural childbirth rate was improved the most by physical exercise intervention started later than 24 weeks of gestation，
followed by that started at 13-24 weeks of gestation，and 12 or less than 12 weeks of gestation. With respect to the type of physical
exercise，the natural childbirth rate was improved the most by pelvic floor muscle training，general sports lessons，gymnastics，
aerobic exercise，birthing ball movement，and yoga. As for the frequency of physical exercise，the natural childbirth rate was
improved the most by at least 12 times per week，followed by 3-5 times per week，6-8 times per week，and 9-11 times per
week. In terms of the intensity of physical exercise，the natural childbirth rate was improved the most by moderate intensity of
physical exercise. With regard to the duration of physical exercise，the natural childbirth rate was improved the most by physical
exercise lasting for 30-<50 minutes per time，followed by less than 30 minutes per time，and at least 50 minutes per time. In
respect to the number of weeks of conducting physical exercise，the natural childbirth rate was improved the most by physical
exercise lasting for 8 or less than 8 consecutive weeks，followed by l7-24 weeks，9-16 weeks，and 25-34 weeks. Funnel plot
assessing publication bias of the studies was basically symmetrical in shape，indicating that the publication bias was generally
weak. The overall quality of evidence concerning improvements in natural childbirth rate by physical exercise interventions in
the studies was rated moderate. Conclusion The results show that proper physical exercise during pregnancy favorably affects
the probability of natural childbirth. The natural childbirth probability could be positively influenced by some types of moderate-
intensity physical exercise interventions，such as pelvic floor muscle training，general sports lessons，gymnastics，aerobic
exercise，birthing ball movement，and yoga，if they are performed at least 12 times per week（30-<50 minutes each time）
within 8 consecutive weeks after 24 weeks of gestation.
【Key words】 Pregnant women；Exercise；Physical exercise；Natural childbirth；Cesarean section；Meta-analysis

妊娠和分娩是人类繁衍的正常生理过程，多数妇女可以 时间节点以及锻炼形式等因素与总体效应之间的关系，提出
自然地分娩婴儿，少数妇女需要采用剖宫产。在有医学指征 最优的锻炼干预方案，为相关医务工作者制定锻炼处方提供
的情况下采用剖宫产术分娩，可有效挽救产妇和婴儿生命 ［1］ 。 参考依据，同时，也为体育产业孕产人群体育服务产品设计
研究表明，剖宫产对产妇与胎儿有较大的危害，容易导致产 与供给工作相关人员提供参考。
［2］
妇脏器损伤、术中羊水栓塞、瘢痕子宫，不利于二次分娩等 ； 1 资料与方法
剖宫产胎儿易发生窒息、湿肺等呼吸系统疾病，多动症发生 1.1 文献检索 以“主题词”和“自由词”相结合的方
率为 11.6%，较顺产胎儿高 5.35% ［3］ 。世界卫生组织（WHO） 式，检索中国知网（CNKI）、中国生物医学文献服务系统
在关于剖宫产率的声明中提出，剖宫产可导致严重的，甚至 （CBM）、维普网中文数据库和 PubMed、EMBase、Web of
是永久性的并发症、残疾或死亡；并指出应该不遗余力地提 Science、Cochrane Library 英文数据库中有关妊娠期体育锻
供有必要的剖宫产服务，而不是致力于使剖宫产率控制在某 炼干预影响自然分娩结果的相关文献，同时追踪相关系统评
个特定水平 ［4］ 。因此，20 世纪 80 年代，WHO 提出世界上任 价所引用的参考文献，检索时间为 1990—2021 年。中文检
何一个地区的剖宫产率应该低于 15% ［5］ 。研究表明，中国的 索词为“怀孕”或“孕期”或“妊娠期”或“自然分娩”或
剖宫产率从 2008 年的 28.8% 上升到 2014 年的 34.9%，2018 “顺产”或“体育运动”或“体育锻炼”或“身体活动”；
年更是达到了 36.7%，剖宫产率位居世界第一 ［6］ 。如此高且 英文检索词为“Pregnant”“Parturient population”“Maternity
快速增长的剖宫产率已经成为我国严重的公共卫生问题，医 population”“Natural Childbirth”“Water
院及社会相关部门应当加以重视 ［7］ 。研究表明，体育锻炼作 Birth”“Athletic sports”“Sports Training”“Sports
为一种非药物性的健康干预方式，方便易行，并且妊娠期进 activity”“Exercise”“Physical activity”。文献检索过程符合
行体育锻炼会对分娩方式产生影响 ［8］ 。然而，妊娠期体育锻 PRISMA 声明中的检索要求。
炼对自然分娩的剂量效应尚不十分清楚，锻炼干预方案如何 1.2 纳入标准与排除标准 根据 Cochrane 系统评价的 PICOS
制定对自然分娩的效果更好还不十分明确。基于此，本研究 原则，纳入标准为：（1）研究对象为孕妇，年龄、民族不限；
对已发表的有关体育锻炼干预对分娩结果的相关随机对照试 （2）干预组以体育锻炼干预为唯一干预方式，对照组进行常
验（RCT）进行全面检索，运用 Meta 分析法，在分析体育锻 规护理知识教育或不进行有规律的体育锻炼；（3）主要观察
炼对自然分娩干预总体效应量的基础上，探讨妊娠期体育锻 孕妇选择分娩的方式；（4）试验设计为 RCT，文献为公开发
炼方案中锻炼时长、锻炼频率、锻炼强度、妊娠期开始锻炼 表的期刊论文。排除标准：（1）高血压、肥胖、糖尿病或先