预防早产儿视网膜病的临床证据

Clinical Evidence for the Prevention of Retinopathy of Prematurity

目的探讨与早产儿视网膜病(retinopathy of prematurity,ROP)预防相关的临床证据及其应用价值。方法采用文献检索方法,检索MEDLINE,OVID,EMBASE和Cochrane图书馆数据库收录文献中,有关预防早产儿视网膜病系统评价和随机对照研究(randomized controlled trial,RCT)或半随机对照研究(quasi-randomized controlled trial,qRCT)并进行分析。检索关键词为:premature infants;retinopathyof prematurity;ROP;prevention of ROP;light exposure reduction;oxygen therapy;indomethacin;inositol;D-penicillamine;corticosteroids;erythropoietin;vitamin E;blood transfusion;breast milk feeding;systemicreview;clinical evidence;randomized or quasi-randomized controlled trials;RCT。结果 10项系统评价和6项随机或半随机对照研究涉及预防早产儿视网膜病的临床试验,包括使用早期避光措施、高血氧饱和度、吲哚美辛、皮质激素、肌糖、D-青霉胺、维生素E、促红细胞生成素、输血和母乳喂养等方法,其中肌糖、D-青霉胺和母乳喂养在一定程度上能降低早产儿视网膜病发病率和严重程度。结论目前临床证据显示,对预防早产儿视网膜病尚无确切有效的可推荐方法,肌糖、D-青霉胺和母乳喂养对预防早产儿视网膜病的作用,尚待更多前瞻性随机或半随机对照研究证实其安全性和有效性。

Objective To explore the clinical evidence for the prevention of retinopathy of prematurity （ROP） and evaluate the clinical application of the preventing evidence. Methods Meta-analyses and randomized or quasi-randomized controlled trials （RCT or qRCT） of preventing retinopathy of prematurity were searched and analyzed from the database of MEDLINE, OVID, EMBASE and Coehrane Library. Results Ten Meta-analyses and six randomized or quasi-randomized controlled trials of clinical trials were found to be involved in light exposure reduction, higher oxygen saturation level, indomethacin, inositol, D-penicillamine, corticosteroids, erythropoietin, vitamin E, blood transfusion and breast milk feeding. Among these trials, inositol, D-penicillamine and breast milk feeding could decrease the incidence and severity of retinopathy of prematurity to some extent. Conclusion Current clinical evidence indicates that there is no definitely safe and effective method to recommend for prevention of retinopathy of prematurity. More prospective randomized or quasi-randomized controlled trials are needed to identify the safety and validity of inositol,D-penicillamine and breast milk feeding.