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中国循证儿科杂志

中国循证儿科杂志 ›› 2017, Vol. 12 ›› Issue (4): 257-262.

• 论著 • 上一篇    下一篇

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

马雪玲1,2,3，张倩男1,2,3， 华子瑜1,2,4,5   

  1. 1 重庆医科大学附属儿童医院新生儿科 重庆，400014；2 儿童发育疾病研究教育部重点实验室 重庆，400014； 3 住院医师规范化培训示范基地 重庆，400014； 4 儿童发育重大疾病国家国际科技合作基地 重庆，400014； 5儿童感染免疫重庆市重点实验室 重庆，400014
  • 收稿日期:2017-05-16 修回日期:2017-08-10 出版日期:2017-08-25 发布日期:2017-08-25
  • 通讯作者: 华子瑜

Administration of pulmonary surfactant via thin catheter: system review and meta-analysis

MA Xue-ling1,2,3, Zhang Qian-nan1,2,3, HUA Zi-yu1,2,4,5   

  1. 1 Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China; 2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China;  3 National Demonstration Base of Standardized Training Base for Resident Physicians，Chongqing 400014, China;  4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China; 5 Chongqing Key Laboratory of Child Infection and Immunity, Chongqing 400014, China
  • Received:2017-05-16 Revised:2017-08-10 Online:2017-08-25 Published:2017-08-25
  • Contact: HUA Zi-yu

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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 assess the efficacy and safety of administration of PS via thin catheter.Methods: Databases including Pubmed, Embase, Cochrane Library, Wanfang Data, CNKI, and JAMA from inception to August 6, 2017 were searched for RCTs about administration of PS via thin catheter, combining with manual retrieval method. Preterm neonates with or threatened by NRDS were given PS via thin catheter in intervention group and via intubation method in control group. Mortality during hospitalization, invasive mechanical ventilation rate in 72 h and during hospitalization were considered as the primary results, meanwhile, the rate of failure of administration of PS in first attempt, PS reflux, repetition of PS administration, serious complications and the duration of supplemental oxygen, the duration of invasive and noninvasive mechanical ventilation were also observed. Jadad scale was used to assess the quality of the included studies. For allocation concealment, the rating standard made by Schulz was used. A meta-analysis was conducted with STATA 14.0 software to sum up the data extracted from the included studies, I2 test was performed to assess the heterogeneity among the studies and Peter's test was used to assess whether publication bias existed.Results: Ultimately, 9 studies scored 3 points according to Jadad scale with allocation concealment were included in the study. Nasal CPAP was used after giving PS via thin catheter in intervention group, whereas PS was given by intubation method in control group, after that invasive mechanical ventilation was carried out in 2 studies and nasal CPAP in the other 7 studies. ①The meta-analysis demonstrated that administration of PS via thin catheter reduced the need for invasive mechanical ventilation in 72 hours (OR=0.570; 95%CI: 0.387-0.840, P=0.005) compared with the intubation method, whereas the mortality during hospitalization and the need for invasive mechanical ventilation during hospitalization were not significantly different. ②The incidence of BPD and pneumothorax was lower in experimental group than control group (OR=0.653; 95%CI: 0.458 -0.932, P=0.019) and (OR=0.565; 95%CI: 0.349-0.915, P=0.020), respectively. However, PS reflux was more frequent in thin catheter group (OR=3.038; 95%CI: 1.622-5.690, P= 0.001). No significant differences were found in other results. Conclusion: As an alternative way of surfactant administration, thin catheter method may reduce the need for mechanical ventilation in 72h and the occurrence of BPD and pneumothorax, but PS reflux seems to be more frequent. Further researches are needed in the future.

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