口服糖溶液缓解早产儿视网膜病变筛查疼痛的Meta分析

Meta-analysis of oral sweet solution for pain relief during eye examinations for retinopathy of prematurity

目的评估口服糖溶液(包括蔗糖和葡萄糖)缓解早产儿视网膜病变(ROP)筛查疼痛的有效性和安全性,增强人文关怀。方法系统检索Pub Med、Embase、OVID全文数据库、Cochrane临床对照试验资料库、万方数字化全文期刊数据库、中国期刊全文数据库、中文科技期刊全文数据库、中国生物医学文献数据库(CBM),检索时间均从建库至2016年12月1日。查询所有葡萄糖或蔗糖应用于缓解ROP筛查疼痛的随机对照试验,按纳入标准进行筛选和质量评价,应用Stata 11.0软件进行Meta分析。结果 9个随机随机对照试验(402例)纳入研究,Meta分析显示,文献具有高度异质性(χ~2=71.05,I^2=87.3%,P<0.05),故采用随机效应模型进行分析,分为糖溶液及糖溶液+奶嘴两个亚组,糖溶液亚组合并效应值SMD=-0.02,95%CI:-0.64~0.60,P=0.944,PIPP评分存在低于正常对照组的趋势;糖溶液+奶嘴亚组合并效应值SMD=-1.50,95%CI:-2.64^-0.36,P=0.010,PIPP评分明显低于正常对照组。敏感性分析显示两组在PIPP评分上的差异结果可靠,Egger's检验显示无明显的发表偏倚。不良反应无差别统计学意义。结论单一口服糖溶液可能对缓解ROP筛查疼痛的作用并不明显,口服糖溶液联合奶嘴对缓解ROP筛查疼痛的效果明显更好,且无明显不良反应。

Objective To evaluate the efficacy and safety of oral sweet solution （including sucrose and glucose solution） for pain relief during eye examinations for retinopathy of prematurity and to strengthen the humanistic care. Methods The randomized controlled tri-als （RCTs） about oral sweet solution （including sucrose and glucose solution） for pain relief during eye examinations for retinopathy of prematurity were searched in PubMed,Embase,OVID full-text database,Cochrane Central Register of Controlled Trials,Wanfang Data, China National Knowledge Infrastructure （CNKI） ,Weipu Date and China Biology Medicine disc （CBM） from their establishment to December 1,2016. The Cochrane Collaboration^ Stata 11.0 Software was used for a Meta-analysis. Results Nine R C T s involving 403 cases were eligible for inclusion in Meta-analysis. Literatures were highly heterogeneous （ ）（2 = 71.05,72 = 87. 3 % , P 〈 0. 05 ） , so the random effects model was adopted and all of them were assigned into two subgroups, PIPP score of sweet solution subgroup lower than the normal control group [ SMD = -0. 02 ,95% C l： （ -0. 64） -（0. 60） ,P =0. 944] ;PIPP score of sugar solution subgroup significantly lower than the normal control group [ SMD = -1.50,95% C I：（ - 2 . 6 4 ） - （ -0. 36） =0. 010]. The sensitivity analysis showed thatthe results were reliable. Egger’s test showed no significant publication bias,and there were no differences in the adverse reactions. Conclusions Single oral sweet solution may be not effectives for pain relief during eye examinations for retinopathy of prematurity, but it combined with pacifier becomes more effective and has no obvious adverse reactions.