对乙酰氨基酚治疗早产儿症状性PDA的系统评价

发布时间：2018-04-14 12:03

本文选题：对乙酰氨基酚 + 动脉导管未闭　；参考：《兰州大学》2017年硕士论文

【摘要】：目的:评价对乙酰氨基酚治疗早产儿症状性动脉导管未闭(sPDA)的有效性、安全性。方法:应用计算机检索中国生物医学文献数据库(CBM)、相关期刊论文(CNKI)、维普数据库(VIP)、万方数据知识服务平台、The Cochrane Library、PubMed,搜集国内外所有关于对乙酰氨基酚用于治疗早产儿症状性动脉导管未闭的随机病例对照试验(RCTs)的相关文献,并通过荟萃分析进行相关文献分析。结果:经过筛选最终有7篇文献纳入研究,合计635名动脉导管未闭患儿。对乙酰氨基酚治疗组对比布洛芬对照组的总闭合率(RR=0.99,95%CI=0.89~1.10,P=0.87)、第一疗程闭合率(RR=1.03,95%CI=0.86~1.23,P=0.78)、第二疗程闭合率(RR=0.84,95%CI=0.54~1.29,P=0.42)、死亡率(RR=0.93,95%CI=0.46~1.88,P=0.84)、平均用药时间(MD=0.02,95%CI=-0.08~0.12,P=0.74)、平均住院时间(SMD=-0.09,95%CI=-0.43~0.25,P=0.60)、主要生化指标(肌酐MD=0.97,95%CI=-11.31~13.25,P=0.88、血小板MD=82.71,95%CI=-0.07~165.49,P=0.05、AST值MD=1.00,95%CI=-1.33~3.34,P=0.40)、不良反应(少尿RR=0.72,95%CI=0.25~2.07,P=0.55、肾功能异常RR=0.99,95%CI=0.19~5.18,P=0.99、消化道出血RR=0.46,95%CI=0.20~1.07,P=0.07、NEC发生率RR=1.22,95%CI=0.57~2.61,P=0.61、高胆红素血症RR=1.15,95%CI=0.18~7.34,P=0.88、IVH发生率RR=0.97,95%CI=0.52~1.80,P=0.91、ROP发生率RR=0.63,95%CI=0.30~1.32,P=0.22、BPD发生率RR=0.81,95%CI=0.35~1.87,P=0.62、败血症RR=0.91,95%CI=0.59~1.39,P=0.66)等差异均无统计学意义。对乙酰氨基酚实验组对比吲哚美辛对照组的总闭合率(RR=1.07,95%CI=0.95~1.20,P=0.29)、消化道出血(RR=1.22,95%CI=0.57~2.61,P=0.60)、NEC(RR=0.68,95%CI=0.20~2.29,P=0.53)、肾功能异常(RR=0.44,95%CI=0.02~12.31,P=0.63)发生率差异无统计学意义,少尿发生率差异有统计学意义。结论:对乙酰氨基酚是用于治疗早产儿动脉导管未闭的一种有效药物,与布洛芬、吲哚美辛等非甾体类抗炎药的不良反应发生率无明显差异。可作为吲哚美辛、布洛芬等非甾体类抗炎药治疗无效或存在用药禁忌时另一种保守治疗药物。
[Abstract]:Objective: To evaluate the acetaminophen treatment of premature infants with symptomatic patent ductus arteriosus (sPDA) the effectiveness of safety. Methods: a computer-based search Chinese biomedical literature database (CBM), Chinese Journal Full-text Database (CNKI), VIP database (VIP), Wanfang database, The Cochrane Library, PubMed collect, all domestic and foreign acetaminophen for treatment of premature infants were randomly symptomatic patent ductus arteriosus (RCTs) control test of related literature, and through meta-analysis of literature analysis. Results: after screening the final 7 papers are included in the study, a total of 635 patent ductus arteriosus closure of the total. Acetaminophen ibuprofen treatment group compared control group (RR=0.99,95%CI=0.89~1.10, P=0.87), the rate of the first course of the closing rate (RR=1.03,95%CI=0.86~1.23, P= 0.78), the second course of the closing rate (RR=0.84,95%CI=0 .54~1.29, P=0.42) (RR=0.93,95%CI=0.46~1.88, P=0.84), the mortality rate, the average treatment time (MD=0.02,95%CI=-0.08~0.12, P=0.74), the average hospitalization time (SMD=-0.09,95%CI=-0.43~0.25, P=0.60), the main biochemical indexes (creatinine MD=0.97,95%CI=-11.31~13.25, P= 0.88, P=0.05, AST value of platelet MD=82.71,95%CI=-0.07~165.49, MD=1.00,95%CI=-1.33~3.34, P=0.40), adverse reactions (RR=0.72,95%CI=0.25~2.07 P=0.55, oliguria, abnormal renal function RR=0.99,95%CI=0.19~5.18, P=0.99, RR=0.46,95%CI=0.20~1.07, P=0.07, gastrointestinal bleeding, the incidence rate of NEC RR=1.22,95%CI=0.57~2.61, P=0.61 P=0.88, IVH RR=1.15,95%CI=0.18~7.34, hyperbilirubinemia, incidence of RR=0.97,95%CI=0.52~1.80, P=0.91, ROP, P=0.22, RR=0.63,95%CI=0.30~1.32 incidence, the incidence rate of BPD RR=0.81,95%CI=0.35~1.87, P=0.62 RR =0.91,95%CI=0.59~1.39 P=0.66), sepsis, differences were not statistically significant. On the B The total phenol in experimental group compared with closed amido group rate of indomethacin (RR=1.07,95%CI=0.95~1.20, P=0.29), gastrointestinal bleeding (RR=1.22,95%CI=0.57~2.61, P=0.60), NEC (RR=0.68,95%CI=0.20~2.29, P=0.53), abnormal renal function (RR=0.44,95%CI=0.02~12.31, P=0.63) no significant differences in the incidence of oliguria, there was a significant difference. Conclusion: Acetaminophen phenol is an effective drug for the treatment of premature infants, patent ductus arteriosus and Bloven, adverse reaction of indomethacin and other non steroidal anti-inflammatory drugs were no significant difference. As indomethacin, invalid or contraindications exist when another conservative treatment of drug treatment of Bloven and other non steroidal anti-inflammatory drugs.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.6

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