LISA技术治疗新生儿呼吸窘迫综合征有效性的系统评价

Systematic review of the effectiveness of intratracheal injection of pulmonary surfactant in the treatment of neonatal respiratory distress syndrome

目的评价经微管气管内注入肺泡表面活性剂(LISA)联合持续气道正压通气(CPAP)序贯技术治疗新生儿呼吸窘迫综合征(RDS)的有效性。方法检索PubMed、EMBASE、Cochrane图书馆、中国期刊全文数据库、万方数据库、维普中文科技期刊数据库及中国生物医学文献数据库,查找所有LISA联合CPAP治疗RDS的随机对照试验。采用RevMan 5.2软件进行meta分析,分别比较胎龄<34周罹患RDS的早产儿中,LISA组和对照组的病死率以及支气管肺发育不良(BPD)、早产儿视网膜病(ROP)、脑室内出血(IVH)、脑室周围白质软化(PVL)等并发症发生率的差异。结果共纳入5篇随机对照研究,含759例患儿。与对照组相比,LISA组患儿机械通气比率低(RR:0.32,95%CI:0.13~0.82);BPD发生率低(RR:0.61,95%CI:0.42~0.88);但两组患儿病死率、ROP、IVH、气胸及PVL发生率差异无统计学意义(P均>0.05)。结论 LISA技术治疗新生儿呼吸窘迫综合征可明显降低机械通气及BPD发生率,但对其他并发症发生率及病死率无影响。

Objective To evaluate the effectiveness of intratracheal injection of pulmonary surfactant （LISA） combined with continuous positive airway pressure （CPAP） on the treatment of neonatal respiratory distress syndrome （RDS）. Methods The databases of PubMed, EMBASE, Cochrane, China National Knowledge Infrastructure （CNKI）, Wanfang Database, Weipu Database and China Biology Medicine disc （CBM） were searched, and all of the randomized controlled trial of LISA combined with CPAP for treatment of RDS were included. RevMan 5.2 was used to perform meta-analysis. The differences of mortality, bronchopulmonary dysplasia （BPD）, retinopathy of prematurity （ROP）, intraventricular hemorrhage （IVH）, periventricular leukomalacia （PVL）, and other complications between LISA group and control group were compared in 〈34 weeks gestational age preterm infants with RDS. Results Five randomized controlled trials were included with 759 infants in total. Compared with control group, the rate of mechanical ventilation （RR： 0.32,95% CI： 0.13-0.82） and the incidence of BPD （RR： 0.61,95% CI： 0.42-0.88） were significantly decreased in LISA group. There were no differences in mortality and the incidences of ROP, IVH, and PVL between two groups （P〉0.05）. Conclusion The mechanical ventilation and the incidence of BPD is significantly reduced in the treatment of neonatal respiratory distress syndrome by LISA, but it has no effect on the incidences of other complications and mortality.