比较定容通气与压力限定通气在早产儿中效益评估的Meta分析

Meta-Analysis of Benefit Evaluation between Volume-targeted Ventilation and Pressure-limited Ventilation in Preterm Infants

目的:比较定容通气(Volume-targeted ventilation,VTV)与压力限定通气(Pressure-limited ventilation,PLV)对早产儿效益评估。方法:计算机检索Pub Med、EMbase、The Cochrane Library(2017年第4期)及CNKI等电子数据库,检索时限为建库至2017年4月1日,由两位研究者独立筛选文献、提取资料。并评价纳入研究的偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果:最终纳入15个随机对照试验,6个交叉试验,共1 427例患者。Meta分析结果显示:与PLV相比,VTV更能够降低病死率[RR=0.68,95%CI(0.51,0.91),I2=0,P=0.82]、减少支气管发育异常[RR=0.73,95%CI(0.60,0.90),I2=25%,P=0.21]、缩短机械通气时间[MD=-2.00,95%CI(-3.14,-0.86),I2=45%,P=0.07]、降低脑室出血(Intraventricular haemorrhage,IVH)[RR=0.65,95%CI(0.42,0.99),I2=53%,P=0.02]、降低3/4级IVH[RR=0.53,95%CI(0.32,0.75),I2=21%,P=0.27]、降低室周白质软化症[RR=0.35,95%CI(0.16,0.66),I2=0,P=0.90],减少气胸[RR=0.46,95%CI(0.25,0.86),I2=0,P=0.85]等。结论:与采用传统呼吸机PLV通气方案相比,VTV通气方案在治疗早产儿方面,可明显降低病死率、BPD发病率,缩短呼吸机通气时长与吸氧时间,降低无效通气率、IVH、3/4级IVH、低碳酸血症、气胸及室周白质软化症等事件发生率。受样本量与研究质量所局限,该研究结果仍需开展更多高质量的RCT来予以验证。

Objective To assess the benefit of volume-targeted ventilation（ VTV） compared with pressure-limited ventilation（ PLV） in preterm infants. Methods The electronic databases of Pub Med,the Cochrane Library（ Issue 4,2017） and China National Knowledge Infrastruture（ CNKI） were searched from inception to April 1,2017. The literature screen and data extraction were performed two researchers independently. After evaluating the risk of bias in the study,the Rev Man 5.2 software was used for Meta analysis. Results Fifteen randomized controlled trials and 6 crossover trials were included in a total of 1427 patients. The Meta analysis results showed that： compared with PLV,VTV can reduce the mortality rate [RR= 0.68,95%CI（ 0.51,0. 90）,I2= 0,P = 0. 82],reduce bronchial dysplasia [RR = 0. 73,95% CI（ 0. 60,0. 90）,I2=25%,P = 0.21],shorten the mechanical ventilation time [MD =-2.00,95%CI（-3.14,-0.86）,I2= 45%,P = 0.07],reduce the intraventricular hemorrhage（ IVH） [RR = 0.65,95%CI（ 0.42,0.99）,I2= 53%,P = 0.02],reduce 3/4 grade IVH [RR = 0.53,95%CI（ 0.32,0.75）,I2= 21%,P = 0.27,reduce the periventricular white matter malacia [RR = 0.35,95% CI（ 0.16,0.66）,I2= 0,P = 0.90],and reduce pneumothorax [RR = 0.46,95%CI（ 0.25,0.86）,I2= 0,P = 0.85].Conclusion Compared with the traditional ventilation ventilator PLV scheme,VTV schemeof ventilation in the treatment of premature infants can significantly reduce the mortality and the incidence of BPD,shorten the time of ventilation and oxygen inhalation,reduce the incidence rate of invalid ventilation,IVH,3/4 grade IVH,hypocapnia,pneumothorax and periventricular leukomalacia. Subject to limitations in sample size and research quality,the results above conclusions still need to be validated by large-scale and high-quality RCTs.