肺表面活性物质治疗新生儿胎粪吸入综合征临床疗效的meta分析

Efficacy of pulmonary surfactant therapy in neonates with meconium aspiration syndrome:a meta-analysis

目的外源性肺表面活性物质(PS)治疗胎粪吸入综合征(MAS)的临床疗效存在争议,本研究对PS治疗MAS的效果进行系统评价,为其临床应用提供循证医学证据。方法计算机检索PubMed、Science CitationIndex、The Cochrane Central Register of Controlled Trials、Ovid、EBSCOhost、BIOSIS previews、中国生物医学文献数据库、万方数据库、维普中文科技期刊数据库关于PS治疗MAS的随机对照试验(RCT)。根据Cochrane系统评价员手册5.0.2版方法评价文献质量,采用RevMan 5.0.25软件进行meta分析。结果共纳入8个RCT,包含512例MAS患儿,其中PS治疗组257例,对照组255例。Meta分析显示,PS治疗MAS,能显著降低氧合指数(MD=-2.59,95%CI:-4.33～-0.86,P=0.003),升高动脉/肺泡氧分压比值(MD=0.05,95%CI:0.05～0.06,P<0.00001),缩短平均住院时间(MD=-4.94,95%CI:-7.44～-2.44,P=0.0001)和降低病死率(OR=0.47,95%CI:0.24～0.93,P=0.03)。而机械通气时间、氧疗时间、气漏发生率、肺出血发生率、颅内出血发生率两组间差异无统计学意义。结论目前证据显示PS替代治疗MAS是有效的,但鉴于该meta分析纳入文献数量有限且质量中等,结论尚需规范的大规模、多中心RCT论证。

Objective The efficacy of pulmonary surfactant（PS） replacement therapy for meconium aspiration syndrome（MAS） remains controversial.This study aimed to evaluate the efficacy of PS therapy in neonates with MAS by a meta-analysis. Methods Randomized controlled trials（RCTs） on the treatment of MAS with PS were searched electronically in medical debases including PubMed,Science Citation Index,The Cochrane Central Register of Controlled Trials,Ovid,EBSCOhost,BIOSIS previews,Chinese BioMedical Literature Database,Wanfang Database and VIP Chinese Sci-Tech Periodical Database.The Cochrane Handbook 5.0.2 was employed to evaluate methodological quality.RevMan 5.0.25 software was used for the meta-analysis. Results Eight RCTs including 512 MAS neonates（257 cases in the PS treatment group and 255 cases in the control group） were enrolled in this meta-analysis.The meta-analysis showed that PS treatment reduced oxygenation index（MD=-2.59;95%CI：-4.33,-0.86;P=0.003）,increased arterial oxygen/alveolar oxygen ratio（MD=0.05;95%CI：0.05,0.06;P〈0.00001）,shortened hospitalization days（MD=-4.94;95%CI：-7.44,-2.44;P=0.0001） and decreased mortality rate（OR=0.47;95%CI：0.24,0.93;P=0.03） significantly.There were no statistical differences in the durations of mechanical ventilation and oxygen therapy,and the incidences of air leak,pulmonary hemorrhage and intracranial hemorrhage between the PS treatment and control groups. Conclusions Currently published evidence from RCTs suggests that PS replacement therapy is effective for MAS,however because of the limited quantity and quality of trials enrolled in the study,further evidence from RCTs is needed to prove the efficacy.