早期或晚期咖啡因治疗早产儿呼吸暂停临床效果的Meta分析

Effects of caffeine use in apnea of prematurity in the early stage versus late stage: A meta-analysis

目的对早期或晚期咖啡因治疗早产儿呼吸暂停的临床疗效进行Meta分析。方法检索Medline、Science Direct、Elsevier、Embase、中国生物医学文献数据库、万方数据库等,收集符合纳入标准的研究,检索时限为从建库至2015年11月,提取符合纳入标准研究的参考文献和手工检索相关会议资料。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,应用Rev Man 5.2软件进行Meta分析。结果共纳入1个随机对照研究,4个回顾性队列研究,共59 288例患儿,Meta分析结果显示,早期咖啡因使用组与晚期咖啡因使用组相比,病死率、支气管肺发育不良、脑室内出血、脑室旁白质软化、早产儿视网膜病及动脉导管未闭手术干预发生率均显著下降（P〈0.05）,坏死性小肠结肠炎发生率两组间比较差异无统计学意义（OR=0.98,95%CI0.72~1.33,P=0.881）。结论早产儿呼吸暂停患儿应尽早开始咖啡因治疗,能显著降低病死率及其他并发症的发生,无明显药物不良反应,临床耐受性好。

Objective To assess the effects of caffeine use in apnea of prematurity （AOP） in the early stage （caffeine was used within 3 days after birth） versus late stage （caffeine was used 4 to 10 days after birth ） . Methods Medline, Science Direct, Elsevier, Embase, CBMdisc and Wanfang databases were retrieved to incorporate studies that met the inclusion criteria. The retrieval time limit was from the establishment of the databases to November, 2015. References that were in line with the inclusion criteria were selected and relevant conference data were collected by manual retrieval. Two researchers conducted meta-analysis using software RevMan 5. 2 after independent data selection, information extraction and quality evaluation according to the inclusion and exclusion criteria. Results One randomized controlled trial and four retrospective cohort studies were included. A total of 59 288 patients were involved. Meta-analysis suggested that, compared with caffeine use in the late stage, the early stage group showed significant lower incidence （ P 〈 0. 05 ） of mortality, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity and surgical intervention of patent ductus arteriosus. No significant difference （OR = 0. 98, 95% CI 0. 72 - 1. 33, P = 0. 881） was observed between the 2 groups in terms of the incidence of＆amp;nbsp;necrotic enterocolitis. Conclusions Patients with AOP should start caffeine treatment as early as possible, which significantly decreases mortality rate and the occurrence of other complications with little adverse reactions and good clinical tolerance.