吸入一氧化氮治疗成人及儿童急性呼吸窘迫综合征并发症meta分析

Nitric oxide inhalation for treating adult and child acute respiratory distress syndrome complications:a meta analysis

目的 对吸入一氧化氮（iNO）治疗成人及儿童急性呼吸窘迫综合征（ARDS）并发症进行meta分析,以期为临床应用提供参考依据。方法 应用计算机检索1990-2014年Cochrane Library、PubMed、EMB Guideline、MD Consult、EBSCO、Science数据库,收录已公开发表的有关iNO治疗ARDS的中、英文文献,以肾功能损伤、颅内出血或脑白质软化（PVL）、视网膜病变、颅神经损伤等发生率作为终点疗效观察指标,得出合并后疗效的优势比（OR）及其95%可信区间（95%CI）,然后进行定性、定量综合评估,按纳入、排除标准对合格文献进行质量评价。结果 （1）iNO治疗组患者中发生肾功能损伤例数（93例）高于对照组（53例）,差异有统计学意义（P〈0.05）;发生PVL例数（26例）与对照组（39例）比较,差异无统计学意义（P〉0.05）;颅神经损伤例数（6例）低于对照组（9例）,但差异无统计学意义（P〉0.05）;（2）神经损伤：视网膜病变例数（9例）低于对照组（13例）,但差异无统计学意义（P〉0.05）。结论 iNO治疗ARDS会增加成人肾功能损伤的风险,因此不推荐使用iNO治疗有肾功能损伤的ARDS成人患者。

Objective To conduct a meta analysis on the nitric oxide （iNO） inhalation for treating adult and child acute respiratory distress syndrome （ARDS） complications in order to provide reference for its clinical application. Methods The published Chinese and English literatures on iNO inhalation for treating ARDS were searched by computer retrieval. With the occur rence rate of renal function injury,intracranial hemorrhage or periventrieular leucomalaeia （PVL）, retinopathy of prematufity, cerebral palsy, etc. as the observation indicators of end point efficacy, the odds ratio （OR） of merged curative effect and 95% confidence interval （95%CI） were obtained. Then the qualitative and quantitative comprehensive evaluation was performed. The qualified literatures were evaluated by the inclusion and exclusion standards. Results （ 1 ）The renal function injury ： the cases number in the iNO treatment group was higher than that in the control group, the difference was statistically significant （93 cases vs. 53 cases, P〈 0.05） ;intracranial hemorrhage or PVL：the difference between the iNO treatment group and the control group had no statistical significance （26 cases vs.39 cases, P〉0.05 ） ; （2）nerve injury （cerebral palsy） ：the iNO treatment group was lower than the control group without statistical difference （6 cases vs. 9 cases, P〉0.05） ;retinopathy：the iNO treatment group was lower than the control group without statistical difference （9 cases vs. 13 cases, P〉0.05）. Conclusion iNO for treating adult ARDS could increase the risk of renal impairment, therefore the use of iNO for treating ARDS adult patients with renal impairment is not recommended.