吸入一氧化氮治疗儿童先天性心脏病术后合并肺动脉高压的近期疗效和安全性的Meta分析

发布时间：2018-03-13 23:17

本文选题：先天性心脏病　切入点：肺动脉高压　出处：《广西医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的评价吸入一氧化氮治疗儿童先天性心脏病(CHD)术后合并肺动脉高压(PAH)的近期疗效和安全性。方法检索美国生物医学数据库（MEDLINE OvidSP）、荷兰医学文摘（EMBASE OvidSP）、Cochrane临床对照试验库（CENTRAL）、中国生物医学文献数据库(CBM)、中国知识资源总库（CNKI）和在研对照试验数据库，检索时间从数据库建库到2012年4月，获得吸入一氧化氮治疗儿童CHD术后合并PAH的RCT文献。采用《Cochrane系统评价员手册5.1.2》推荐的随机方法、分配隐藏、盲法、随访偏倚、结果数据的完整性和其他偏倚来源评价纳入的文献的方法学质量。用RevMan5.1软件进行Meta分析，根据异质性结果选择相应的效应模式分析，对无法合并行Meta分析的结果进行描述性分析。结果共检索到相关文献984篇，其中6篇符合标准的RCT文献进入Meta分析，涉及研究对象220例。纳入文献方法学质量评价结果显示，2篇文献存在低度偏倚风险，1篇文献存在中度偏倚风险，3篇文献存在高度偏倚风险。①研究结果显示，吸入一氧化氮可降低收缩期肺动脉压（SMD=-0.83(95%CI=-1.40--0.26,p=0.004)，显著缩短拔管时间、机械通气时间和重症监护时间。②吸入一氧化氮组出院前病死率、肺动脉高压危象发生率、平均肺动脉压、平均动脉压、心率、心排血指数、氧合指数与对照组差异均无统计学意义。③吸入一氧化氮可显著提高高铁血红蛋白浓度（MD=0.40，95%CI=0.20-0.60,p0.0001)和二氧化氮浓度，但仍在正常范围内。结论现有数据显示，吸入NO未能显著的降低出院前病死率、肺动脉高压危象发生率和平均肺动脉压，亦未能显著提高心排血指数和氧合指数。但吸入NO可能有效降低收缩期肺动脉压、拔管时间、机械通气时间和重症监护时间。鉴于此次研究纳入的RCT文献研究对象少，文献总体质量不高，研究间存在异质性，故应谨慎对待本研究结论，对于一氧化氮的确切疗效应开展前瞻性、大样本、多中心的随机对照试验进一步论证。
[Abstract]:Objective to evaluate the short-term efficacy and safety of inhaled nitric oxide (no) in the treatment of children with congenital heart disease (CHD) with pulmonary hypertension (PAH).
The United States biomedical database retrieval method (MEDLINE OvidSP), Holland Medical Abstracts (EMBASE OvidSP), Cochrane clinical controlled trials database (CENTRAL), Chinese biomedical literature database (CBM), China knowledge resources database (CNKI) and in the research of controlled trials database, retrieved from the database by April 2012, PAH RCT combined with literature get inhaled nitric oxide therapy in children with CHD after operation. The stochastic method using the recommended allocation concealment and blinding, follow-up bias, quality methods into the integrity of the data and other sources of bias evaluation results. Meta analysis was carried out using RevMan5.1 software according to the heterogeneity of the corresponding mode selection effect the analysis, descriptive analysis of Meta cannot merge the results of the analysis.
Results a total of 984 literatures, 6 of them in accordance with the standard RCT documents into Meta analysis, involving 220 subjects included in the literature. The methodological quality evaluation results show that 2 articles have a low risk of bias, 1 articles with moderate bias risk and 3 RCTs with high risk of bias. The results showed that that inhaled nitric oxide can reduce systolic pulmonary artery pressure (SMD=-0.83 (95%CI=-1.40--0.26, p=0.004), significantly shorten the extubation time, duration of mechanical ventilation and intensive care time. The inhaled nitric oxide before the discharge mortality rate, the incidence of pulmonary hypertension, mean pulmonary arterial pressure, mean arterial pressure, heart rate, cardiac index, oxygen composite index showed no significant difference from the control group. The inhaled nitric oxide can significantly increase the concentration of methemoglobin (MD=0.40,95%CI=0.20-0.60, P0.0001) and two nitric oxide concentrations, but still in it In a constant range.
Conclusion the existing data show that inhaled NO failed to significantly reduce mortality before discharge, pulmonary hypertension incidence and mean pulmonary artery pressure, also failed to significantly improve cardiac index and oxygen index. But inhaled NO may be effective in decreasing systolic pulmonary artery pressure, extubation time, mechanical ventilation time and duration of intensive care in view of the research into RCT. Literature research object, the overall quality of literature is not high, there is heterogeneity among the studies, the conclusions of this study should be treated with caution, for the exact therapeutic effects of nitric oxide in a prospective, large sample, multi center randomized controlled trials further demonstrated.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.5

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