复苏技术降低中国新生儿窒息发生率和死亡率的系统评价

Neonatal Resuscitation Technique in Reducing Neonatal Asphyxia Rate and Mortality Rate in China:A Systematic Review

目的系统评价我国推广新生儿复苏技术救治新生儿窒息的有效性。方法计算机检索Wan Fang Data、CNKI、VIP、江苏工程信息文献中心、Pub Med、The Cochrane Library(2016年5期)等数据库,搜集复苏技术救治新生儿窒息的研究,检索时间均为建库至2016年6月1日。由2名评价者按纳入与排除标准独立筛选文献、提取资料并评价偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果共纳入18个观察性研究,包括28 144例新生儿窒息患儿和32 636例对照及2 148例新生儿窒息死亡病例和1 679例对照。Meta分析结果显示,与对照组相比,复苏技术能降低新生儿窒息发生率[以医院为基础的研究:RR=0.59,95%CI(0.55,0.63),P<0.000 01;区域性项目专题调查研究:RR=0.72,95%CI(0.69,0.75),P<0.000 01]和新生窒息死亡率[以医院为基础的研究:RR=0.26,95%CI(0.16,0.42),P<0.000 01;区域性研究:RR=0.65,95%CI(0.55,0.77),P<0.000 01],其差异均有统计学意义。结论当前证据表明新生儿复苏技术对降低我国新生儿窒息发生率和死亡率有效。受纳入研究的数量和质量限制,本研究结论还需要开展前瞻性多中心队列研究予以验证。

Objective To systematically review the efficacy of promoting neonatal resuscitation technique in treatment of neonatal asphyxia in China. Methods Electronical databases including WanFang Data, CNKI, VIP, ~iangsu Engineering and Technology Literature Information Center, PubMed and The Cochrane Library （Issue 5, 2016） were searched to collect studies of neonatal resuscitation technique in treatment of neonatal asphyxia up to June 1st, 2016. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then meta- analysis was performed by using RevMan 5.2 software. Results A total of eighteen observational studies were included, involving 28 144 cases of neonatal asphyxia and 32 636 cases of control, 2 148 death cases of neonatal asphyxia and 1 679 cases of controls. The results of meta-analysis showed that neonatal resuscitation technique could reduce newborn suffocation rate compared with the control group in hospital surveys （gg=0.59, 95%CI 0.55 to 0.63, P〈0.000 01） and in regional project surveys （RR=0.72, 95%CI 0.69 to 0.75, P〈0.000 01）. Neonatal resuscitation could also reduce neonatal asphyxia mortality rate in hospital surveys （RR=0.26, 95%CI 0.16 to 0.42, P〈0.000 01） and in regional surveys （RR=0.65, 95%CI 0.55 to 0.77, P〈0.000 01）. Conclusion The existing evidence shows that neonatal resuscitation technology could effectively reduce the incidence of neonatal asphyxia and mortality rate in China. Due to the limitations of the quantity and quality of present studies, we need to carry out prospective multicenter cohort studies to verify the current results.