生后早期经气道给予糖皮质激素预防早产儿支气管肺发育不良临床疗效的Meta分析

Clinical efficacy of glucocorticoid administration via airway in the early postpartum period to prevent bronchopulmonary dysplasia in premature infants:a systematic review and meta-analysis

目的系统评价生后早期经气道给予糖皮质激素预防早产儿支气管肺发育不良( Bronchopulmonary dysplasia,BPD)的有效性和安全性。方法检索中国知网、维普中文科技期刊数据库、万方、PubMed、Embase、Cochrane Library 等,检索时间为建库至2018 年10 月,并辅以手工检索,尽可能全面地收集生后早期经气道给予糖皮质激素预防早产儿支气管肺发育不良的随机对照试验文献,试验组生后早期经气道给予糖皮质激素治疗,对照组给予安慰剂或为空白对照。对文献进行资料筛选和质量评价,应用RevMan 5. 3 软件进行Meta 分析。结果共9 篇随机对照试验纳入该Meta 分析,包括1 891 例患儿,其中对照组941 例,试验组950 例。Meta 分析显示:两组间BPD 的发生率比较差异有统计学意义( P < 0. 000 01),而死亡率比较差异无统计学意义( P =0. 36);实验组早产儿视网膜病变( OR= 1. 06,95% CI: 0. 83 ~ 1. 36)、坏死性小肠结肠炎( OR= 0. 86,95% CI:0. 63 ~ 1. 19)、新生儿败血症( OR= 1. 02,95%CI: 0. 81 ~ 1. 28)、脑室内出血( OR= 0. 97,95% CI: 0. 73 ~ 1. 29)、脑室周围白质软化( OR= 1. 04,95%CI: 0. 44 ~ 2. 48)发生率与对照组相比,差异无统计学意义( P > 0. 05)。结论当前证据表明,生后早期经气道给予糖皮质激素可有效降低早产儿BPD 的发生风险,且不会增加早产儿死亡率及相关并发症的发生率。

Objective To systematically evaluate the efficacy and safety of early postnatal administration of glucocorticoids via airway to prevent bronchopulmonary dysplasia ( BPD) in premature infants. Methods The CNKI, Vip,Wanfang,PubMed,Embase,Cochrane Library were searched. Search time was from the establishment of the database to October 2018, and manual search was also performed. Collect as comprehensively as possible the randomized controlled experimental literatures on the prevention of bronchopulmonary dysplasia by glucocorticoid in early postnatal period via airway. The experimental group was given glucocorticoid in early postnatal period via airway. The control group was given placebo or as blank control. The literature was screened and evaluated. Meta-analysis was carried out with RevMan 5. 3 software. Results Nine randomized controlled trials were included in the meta-analysis, including 1 891 patients, 941 in the control group and 950 in the experimental group. Meta-analysis showed that there were significant differences in the incidence of bronchopulmonary dysplasia between the control group and the experimental group ( P < 0. 000 01),but there was no significant difference in mortality between the two groups( P = 0. 36);the incidence of retinopathy in premature infants ( OR = 1. 06, 95%CI: 0. 83 ~ 1. 36),necrotizing enterocolitis ( OR = 0. 86, 95% CI: 0. 63 ~ 1. 19),neonatal sepsis ( OR = 1. 02,95% CI: 0. 81 ~ 1. 28), intraventricular hemorrhage ( OR = 0. 97,95% CI: 0. 73 ~ 1. 29) and periventricular leukomalacia ( OR = 1. 04,95% CI: 0. 44 ~ 2. 48) in the experimental group had no significant difference compared with the control group ( P > 0. 05). Conclusion Current evidence shows that early intratracheal administration of glucocorticoids via airway can effectively reduce the risk of bronchopulmonary dysplasia in premature infants without increasing premature infant mortality and related complications.