细导管法给予肺表面活性物质安全性和疗效的系统评价和Meta分析

发布时间：2018-02-10 01:15

本文关键词： 细导管法肺表面活性物质 Meta分析　出处：《中国循证儿科杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的系统评价细导管法给予肺表面活性物质(PS)的安全性和疗效。方法计算机检索Pubmed、Embase、Cochrane Library、JAMA、万方和中国知网数据库,检索时间为建库至2017年8月6日,纳入生后自主呼吸、有RDS风险或征象的早产儿,采用细导管法(试验组)和传统气管插管方式(对照组)给予PS的RCT。主要结局指标:住院期间病死率,72 h内和住院期间有创机械通气率。次要结局指标:首次给PS失败率(未能插管到预定位置)、PS反流率、重复给予PS率、并发症、住院期间有创/无创通气时间和住院期间总吸氧时间。采用Jadad量表评价文献质量,根据Schulz对分配隐藏的情况分级。用stata14.0软件进行分析,I2检验对效应量进行异质性检验,Peters法检测发表偏倚。结果 9篇文献进入Meta分析,Jadad量表评分均3分,均体现分配隐藏。试验组均以细导管法给予PS后行经鼻赛持续气道正压通气(NCPAP);对照组2篇为传统气管插管给予PS并行有创机械通气,余均以气管插管-PS-拔管方式给予与试验组等量PS后行NCPAP。(1)试验组72 h内有创机械通气率低于对照组(OR=0.570;95%CI:0.387~0.840,P=0.005)。试验组住院期间病死率和住院期间有创机械通气率与对照组差异无统计学意义。(2)试验组支气管肺发育不良(BPD)(OR=0.653,95%CI:0.458~0.932,P=0.019)和气胸(OR=0.565,95%CI:0.349~0.915,P=0.020)发生率低于对照组,PS反流率高于对照组(OR=3.038,95%CI:1.622~5.690,P=0.001);其他次要结局指标差异均无统计学意义。结论细导管法与气管插管法给予PS相比,有减低72 h有创机械通气需要、BPD和气胸发生率的可能,但PS反流率较高,有待进一步研究。
[Abstract]:Objective to systematically evaluate the safety and efficacy of pulmonary surfactant (PSN) administered with small ducts. Methods the database of Pubmedmedus Embase Cochrane Library Jama, Wanfang and China KnowledgeNet was searched by computer, and the retrieval time was from August 6th 2017 to August 6th 2017, and was included in spontaneous respiration after birth. Premature infants with RDS risk or signs, RCTs of PS were given to patients with small ducts (test group) and traditional endotracheal intubation (control group). Main outcome measures: mortality during hospitalization and invasive mechanical ventilation rate during hospitalization. Secondary outcome measures: first given. PS failure rate (failure to intubate to a predetermined location for PS reflux rate, PS rate, complications, duration of invasive / noninvasive ventilation during hospitalization and total duration of oxygen inhalation during hospitalization were repeated. The literature quality was evaluated by Jadad scale. According to the classification of distribution and hiding by Schulz, the heterogeneity test of effect quantity was performed by stata14.0 software, and the publication bias was detected by Peters method. Results the scores of 9 articles in Meta analysis and Jadad scale were all 3 points. The experimental group were treated with PS after nasal continuous positive airway pressure ventilation and the control group were treated with traditional endotracheal intubation with PS plus invasive mechanical ventilation. The rate of invasive mechanical ventilation in the test group was lower than that in the control group within 72 hours. The mortality rate during hospitalization and the rate of invasive mechanical ventilation in the test group were lower than those in the control group. The mortality rate and the invasive mechanical ventilation rate during hospitalization in the test group were lower than those in the control group. The incidence of bronchopulmonary dysplasia in the test group was 0.65395 CI: 0.4580.932% (P0.019) and pneumothorax 0.56595CIW 0.56595CIW 0.3490.915 P0. 020) the incidence of PS reflux in the test group was lower than that in the control group (OR3.03895CI1: 1.6225.690), and there was no significant difference in the other secondary indexes. Conclusion there is no significant difference in the outcome of tracheobronchial catheterization and tracheobronchial insertion. Compared with PS, It is possible to reduce the incidence of bpd and pneumothorax in 72 h invasive mechanical ventilation, but PS reflux rate is high, which needs further study.
【作者单位】：重庆医科大学附属儿童医院新生儿科;儿童发育疾病研究教育部重点实验室;住院医师规范化培训示范基地;儿童发育重大疾病国家国际科技合作基地;儿童感染免疫重庆市重点实;
【分类号】：R722.6

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