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中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (4): 259-264.

• 论著 • 上一篇    下一篇

生后7天内气道内应用布地奈德对早产儿支气管肺发育不良发生率影响的系统评价和Meta分析

陈奕江1,张水堂2,杨润娜1   

  1. 1 广州中医药大学研究生院 广州，510000；2 广州中医药大学附属南海妇产儿童医院新生儿科 佛山，528200
  • 收稿日期:2016-07-03 修回日期:2016-08-29 出版日期:2016-08-25 发布日期:2016-08-25
  • 通讯作者: 张水堂

Intratracheal administration of budesonide within seven days after birth for preventing bronchopulmonary dysplasia in preterm infants: a systematic review and meta-analysis

CHEN Yi-jiang1, ZHANG Shui-tang2, YANG Run-na1   

  1. 1 Graduate School, Guangzhou University of Chinese Medicine, Guangzhou 510000; 2 Neonatal Department, Nanhai Maternity and Children′s Hospital affiliated to Guangzhou University of Chinese Medicine, Foshan 528200,China
  • Received:2016-07-03 Revised:2016-08-29 Online:2016-08-25 Published:2016-08-25
  • Contact: ZHANG Shui-tang

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摘要：

目的 采用Meta分析方法评估早期（生后7 d内）气道内应用布地奈德对早产儿支气管肺发育不良（BPD）发生率的影响。 方法 检索PubMed、EMBASE、the Cohrane Library、中国知网及万方数据库，收集相关RCT文献，检索时间均为建库至2016年6月1日。由2位研究者独立行文献筛选、质量评估及资料提取。采用RevMan 5.3软件进行Meta分析，并根据布地奈德给药方式［雾化吸入（雾化吸入亚组）、联合肺表面活性物质气管内滴入（气管内滴入亚组）］行分层分析。结果 6篇RCT文献（n=1 347）进入本文Meta分析。4篇文献描述了随机序列产生，均采用了分配隐藏，均对试验实施者施盲，均未选择性报告研究结果，均描述了脱落或失访，总体偏倚风险较低。①布地奈德组与对照组的BPD发生率差异有统计学意义，固定效应模型合并RR=0.67(95%CI:0.57~0.78)，雾化吸入亚组和气管内滴入亚组的BPD发生率均与对照组差异有统计学意义，RR分别为0.74（95%CI：0.61~0.90）和0.53（95%CI：0.40~0.70）。②布地奈德组与对照组的病死率差异无统计学意义，随机效应模型合并RR=0.94(95%CI:0.60~1.47)。③布地奈德组与对照组的BPD发生率或病死率差异有统计学意义，随机效应模型合并RR=0.74(95%CI:0.60~0.91)，其中雾化吸入亚组与对照组差异无统计学意义，RR=0.87（95%CI：0.76~1.00），气管内滴入亚组与对照组差异有统计学意义，RR=0.60（95%CI：0.49~0.74）。④布地奈德组与对照组的感染（脓毒症）、早产儿视网膜病变发生率差异均无统计学意义，固定效应模型合并RR分别为1.09(95%CI:0.92~1.28)和1.05（95%CI:0.89~1.24）。结论 早期气道内应用布地奈德可降低早产儿BPD的发生率，且联合肺表面活性物质气管内滴入的给药方法可能优于雾化吸入。

Abstract:

Objective To review the efficacy of early intratracheal administration of budesonide for preventing bronchopulmonary dysplasia (BPD) in preterm neonates using meta-analysis methods.Methods Related literatures were retrieved in PubMed, EMBASE, the Cohrane Library, CNKI and Wanfang Database from establishment to June 2016. Two reviewers independently screened literatures, extracted data, and assessed the quality of included studies. The meta-analysis was performed by RevMan 5.3 software. A subgroup analysis about delivery method was made between inhalation (subgroup A) and using surfactant as a vehicle (subgroup B). Results Six randomized controlled trials (1 347 infants) with low risk of bias were included in meta-analysis. The analysis showed that the incidence of BPD was decreased in experimental groups, the RR and 95%CI was 0.67(0.57,0.78), and similar trends were found in subgroup A and B, the corresponding RR and 95%CI was 0.74(0.61,0.90) and 0.53(0.40,0.70), respectively. There was no significant difference in mortality between experimental and control groups, the corresponding RR and 95% CI was 0.94(0.60,1.47). However, the incidence of BPD or death was lower in experimental groups, the RR and 95%CI was 0.74(0.60,0.91), and the incidence of BPD or death was lower in subgroup B than that in subgroup A, the corresponding RR and 95%CI was 0.60(0.49,0.74) and 0.87(0.76,1.00), respectively. There was no significant difference in the incidence of infection (sepsis) or retinopathy of prematurity between experimental and control groups.Conclusion The incidence of BPD can be decreased by early intratracheal administration of budesonide, and the delivery method of using surfactant as a vehicle may be better than inhalation.