动物源性肺表面活性剂治疗新生儿呼吸窘迫综合征的Meta分析

Systematic review and Meta-analysis of animal-derived pulmonary surfactants in the treatment of premature infants with respiratory distress syndrome

目的系统评价动物源性肺表面活性剂(PS)治疗早产儿呼吸窘迫综合征(NRDS)的疗效及安全性。方法计算机检索PubMed、Embase、Cochrane Library临床试验库和系统评价数据库及临床试验注册中心的随机对照试验(RCT),检索时间均为建库至2019年6月30日。按照纳排标准筛选文献,提取数据并进行方法学质量评价,采用RevMan 5.3.5软件进行Meta分析。结果本研究共纳入4篇文献,涉及261例患儿,男女患儿比例近似3:2。Meta分析显示:在经鼻持续气道正压通气(CPAP)基础上加用动物源性PS,可以有效降低机械通气的使用(RR=0.67,95%CI:0.52~0.88,P=0.003)及气胸的发生情况(RR=0.16,95%CI:0.03~0.87,P=0.03);但在死亡(RR=0.61,95%CI:0.08~4.48,P=0.62)及支气管肺发育不良(RR=1.22,95%CI:0.04~39.08,P=0.91)方面,观察组(PS+CPAP)与对照组(CPAP)无明显差异。纳入的4篇研究方法学质量较高。结论动物源性PS联用CPAP可以有效降低早产儿NRDS机械通气的使用及气胸的发生情况。由于入组患儿病情较轻,且受到伦理、试验安全性影响,研究未观测到死亡及支气管肺发育不良情况的疗效差异。

Objective To evaluate the effectiveness and safety of animal-derived pulmonary surfactants(PS)in the treatment of premature infants with respiratory distress syndrome(NRDS).Methods PubMed,Embase,Cochrane Database of Systematic Reviews,Cochrane Central Register of Controlled Trials and Clinical trials register center were systematically and comprehensively searched for published randomized controlled trials of animal-derived pulmonary surfactants in the treatment of neonatal respiratory distress syndrome.The retrieval time was up to Jun 30 th,2019.These articles were screened according to pre-established inclusion and exclusion criteria.The data were extracted and the methodological quality was assessed by researchers independently,and Review Manager 5.3.5 was used for the Meta-analysis.Results Total of 4 studies involving 261 premature infants were included and the ratio of male to female was approximately 3:2.Meta-analysis showed that continuous positive airway pressure(CPAP)combined with PS could reduce the use of mechanical ventilation(RR=0.67,95%CI:0.52-0.88,P=0.003)and the incidence of pneumothorax(RR=0.16,95%CI:0.03-0.87,P=0.03).However,in death(RR:0.61,95%CI:0.08-4.48,P=0.62)and bronchopulmonary dysplasia(RR=1.22,95%CI:0.04-39.08,P=0.91)there were no significant difference between the two groups.The 4 included research had high methodological quality.Conclusion PS+CPAP can effectively reduce the use of mechanical ventilation and the incidence of pneumothorax in premature infants with NRDS.Due to the relatively mild illness of the enrolled premature infants and the influence of ethics and clinical safety,no difference of death and bronchopulmonary dysplasia were observed in these studies.