持续正压通气治疗早产儿失败的危险因素及结局的系统评价和Meta分析

A systematic review and meta-analysis of the risk factors and outcome of continuous positive pressure ventilation failure in preterm infants

目的系统评价持续正压通气(CPAP)治疗早产儿失败的危险因素及其对早产儿结局的影响。方法检索PubMed、Embase、Cochrane图书馆、中国生物医学、中国知网、万方数据库、维普中文科技期刊数据库,检索起止时间均从建库起至2019年4月1日。纳入CPAP治疗早产儿失败的原因分析及CPAP治疗失败后对早产儿结局影响的病例对照和队列研究的文献。采用NOS量表对纳入文献质量进行评价。采用Rev Man 5.3对CPAP治疗失败的危险因素及CPAP治疗失败对早产儿结局的影响进行统计分析。计数资料选取两个率的比值比(OR)及其95%CI表示,计量资料选取标准均数差(SMD)及95%CI表示。结果共纳入10篇文献13075例早产儿。治疗失败危险因素:胎龄、出生体重、产前激素、多胎、男性、CPAP初始PEEP、初始FiO2、重度RDS的OR/SMD及95%CI分别为:-0.83(-1.10^-0.55)、-0.97(-1.39^-0.55)、0.83(0.76~0.90)、0.88(0.79~0.98)、1.29(1.19~1.40)、0.96(0.54~1.38)、7.6(3.93~11.26)、5.94(3.55~9.94),P均<0.05;母并发症、剖宫产、胎膜早破、1 min Apgar、5 min Apgar评分对CPAP治疗失败没有影响,P均>0.05。结局指标中:CPAP治疗失败对早产儿病死率、支气管肺发育不良(BPD)、气胸、重度早产儿视网膜病(ROP)、坏死性小肠结肠炎(NEC)、颅内出血(IVH)发生率的OR(95%CI)分别为5.07(3.66~7.01)、3.99(3.50~4.55)、11.32(1.74~73.69)、2.25(1.54~3.27)、2.42(1.78~3.29)、3.64(2.58~5.15),P均<0.05。结论低胎龄、低出生体重、多胎、男性、高CPAP初始PEEP及FiO2、RDS是CPAP治疗失败的危险因素,产前激素是CPAP失败保护因素。CPAP治疗失败会造成早产儿病死率、BPD、气胸、ROP、NEC、IVH发生率的增加。

Objective To systematically evaluate the risk factors of failure of continuous positive pressure ventilation(CPAP) for premature infants and its effect on the outcome of premature infants. Methods PubMed, EMBASE, The Cochrane library, CBM, CNKI, Wanfang and VIP were selected to search the analysis of the causes of failure of CPAP treatment for premature infants and the influence of failure of CPAP treatment on the outcome of premature infants from initiation establishment of database to April 1 st 2019. The quality of the included studies were assessed. Statistical analysis was performed employing Rev Man 5.3. Effects were expressed by odds ratio(OR), standardized mean difference(SMD) and 95%CI for categorical variables. Results Only 10 trials with 13,075 cases were included. The risk factors(gestational age, birth weight, antenatal steroids, plurality, men, PEEP, FiO2, RDS) of the OR/SMD and 95% CI were distributed as follows:-0.83(-1.10,-0.55),-0.97(-1.39,-0.55), 0.83(0.76,0.90), 0.88(0.79,0.98), 1.29(1.19,1.40), 0.96(0.54,1.38), 7.6(3.93,11.26), 5.94(3.55,9.94)and P<0.05. The difference of other risk factors had no statistically significance. The outcomes of the OR/SMD and 95%CI were distributed as follows: 5.07(3.66, 7.01), 3.99(3.50, 4.55), 11.32(1.74,73.69), 2.25(1.54,3.27), 2.42(1.78,3.29), 3.64(2.58,5.15)and P<0.05. Conclusion The low gestational age, low birth weight, plurality, men, PEEP, FiO2, RDS are risk factors for CPAP failure, and antenatal steroids is a protective factor for it. Failure of CPAP treatment will lead to the increase of premature infant mortality, BPD, pneumothorax, ROP, NEC and IVH.