噻嗪类联合螺内酯治疗早产儿支气管肺发育不良的Meta分析

发布时间：2018-01-02 04:10

本文关键词：噻嗪类联合螺内酯治疗早产儿支气管肺发育不良的Meta分析　出处：《重庆医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的评价噻嗪类联合螺内酯治疗早产儿支气管肺发育不良（BPD）的肺功能改变、临床疗效及安全性。方法检索PubMed、MEDLINE、EMBASE、the CochraneControlled Trials Register (CCTR)、中国生物医学文献数据库、万方数据库及维普中文科技期刊数据库（建库至2013年4月），获得噻嗪类联合螺内酯治疗早产儿支气管肺发育不良的随机对照试验（RCT）文献。根据Cochrane中心推荐的方法进行文献质量评价，采用RevMan5.0.23软件进行Meta分析。结果最终纳入5篇RCT文献，共148例BPD患儿。Meta分析显示，①噻嗪类联合螺内酯治疗早产儿BPD，能显著升高动态肺顺应性（SMD=0.65，95%CI:0.13~1.18，P=0.02），根据治疗时间行亚组分析，提示该作用在治疗后1~2周及4~5周显著，，在治疗后8~10周两组差异无统计学意义。在气道阻力方面两组差异无统计学意义，但亚组分析显示治疗组气道阻力在治疗后1~2周有显著降低（MD=-27.39，95%CI:-37.84~-16.95，P0.00001）。②噻嗪类联合螺内酯组与对照组比较：病死率显著降低（RR=0.30，95%CI:0.09~0.93，P=0.04），吸入氧分数显著降低（MD=-0.05，95%CI:-0.09~-0.01，P=0.03），而机械通气需求率、氧疗时间、住院时间、因呼吸恶化再入院率两组差异无统计学意义。③不良反应发生情况：治疗组血钠浓度明显降低（MD=-2.22，95%CI:-3.18~-1.26，P0.00001），尿钙排除率显著减少（MD=-1.46，95%CI:-2.67~-0.24，P=0.02），电解质补充率显著增加（RR=1.70，95%CI:1.12~2.57，P=0.01），血钾浓度、液体摄入量、肾钙沉着症及听力损害发生率两组差异无统计学意义。结论噻嗪类联合螺内酯治疗早产儿BPD可短期显著改善肺功能，降低病死率和吸入氧分数，仍需警惕电解质失衡、肾钙沉着症、听力损害等不良反应发生。鉴于该Meta分析纳入文献较少，尚需开展设计更严密的多中心、大样本临床试验论证。
[Abstract]:Objective to evaluate the clinical efficacy and safety of thiazide combined with spironolactone in the treatment of premature infants with bronchopulmonary dysplasia (BPDD). Methods PubMedus MEDLINEN EMBASE was searched. The CochraneControlled Trials Register, China Biomedical Literature Database. Wanfang Database and Weipu Chinese Science and Technology Journal Database (established until April 2013). A randomized controlled trial of thiazines combined with spironolactone for the treatment of bronchopulmonary dysplasia in premature infants was obtained. The quality of the literature was evaluated according to the method recommended by the Cochrane Center. Meta analysis was carried out with RevMan5.0.23 software. Results A total of 148 children with BPD were included in 5 articles of RCT. Meta-analysis showed that thiazide combined with spironolactone was used to treat BPD in premature infants. It could significantly increase the dynamic lung compliance and SMD-0.65C95 CI: 0.131.18P0.020.The subgroup analysis was carried out according to the time of treatment. The results suggested that the effect was significant at 1 ~ 2 and 4 ~ 5 weeks after treatment, but had no significant difference between the two groups at 8 ~ 10 weeks after treatment, but had no significant difference in airway resistance between the two groups. However, the subgroup analysis showed that the airway resistance in the treatment group was significantly lower than that in the control group at 1 and 2 weeks after treatment, and MD-27.39% 95: CI-37.84 / -16.95. Compared with the control group, the mortality rate of the thiazide combined with spironolactone group was significantly lower than that of the control group. The mortality rate of the thiazide combined with spironolactone group was significantly lower than that of the control group. The inhaled oxygen fraction significantly decreased MD-0.05 ~ 95% CI: -0.09 ~ -0.01 ~ (-1) P 0.03, while the mechanical ventilation demand rate, oxygen therapy time, and hospitalization time. There was no significant difference in the incidence of adverse reactions between the two groups because of respiratory deterioration: the serum sodium concentration in the treatment group was significantly lower than that in the control group (MD-2.22 ~ 95 CI: -3.18) -1.26. P0.00001, urine calcium removal rate significantly decreased MD-1.4695, CI: -2.67 -0.24 P0. 02) (P < 0. 0001, P < 0. 0001, P < 0. 001, P < 0. 001, P = 0. 02). The electrolyte supplementation rate significantly increased RRX 1.70 ~ 95% CI: 1.122.57%, blood potassium concentration and fluid intake. There was no significant difference in the incidence of renal calcinosis and hearing impairment between the two groups. Conclusion the treatment of BPD with thiazide combined with spironolactone can significantly improve lung function, reduce mortality and oxygen fraction in premature infants in the short term. It is necessary to guard against electrolyte imbalance and renal calcinosis. In view of the small amount of literature included in the Meta analysis, it is necessary to develop a more tightly designed multicenter, large sample clinical trial demonstration.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R722.6

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