高频振荡通气在极低和超低出生体重儿中应用的Meta分析

Meta-analysis of the application of high-frequency oscillation ventilation in very low birth weight and extremely low birth weight infants

目的评价高频振荡通气(HFOV)对比常频机械通气(CMV)对极低出生体重儿(VLBWI)和超低出生体重儿(ELBWI)的影响。方法检索PubMed、Cochrane图书馆、EMBASE、万方数据库(CNKI)、维普数据库、中国期刊全文数据库,检索文献起止时间均从建库起至2019年12月。纳入试验组采用HFOV、对照组采用CMV的对VLBWI和ELBWI影响的随机及半随机对照试验。采用Rev Man 5.2.7软件进行Meta分析。结果纳入12篇文献的Meta分析结果显示:与CMV组比较,HFOV组通气时间更短(MD=-32.27,P=0.001),支气管肺发育不良(BPD)发生率下降(RR=0.74,P<0.05),早产儿视网膜病变(ROP)(≥2期)的发生率下降(RR=0.80,P<0.05);且气漏综合征(RR=1,P=0.97)、脑室内出血(3级或4级)(RR=1,P=0.98)、脑室周围白质软化(RR=0.79,P=0.16)的发生率差异均无统计学意义。结论HFOV可降低VLBWI和ELBWI的BPD、ROP的发生率,不影响脑室内出血(3级或4级)、脑室周围白质软化的发生,但对长期的肺功能及神经系统发育的影响仍需进一步研究。

Objective To evaluate the effects of high-frequency oscillation ventilation(HFOV)versus conventional mechanical ventilation(CMV)on very low birth weight infants(VLBWI)and extremely low birth weight infants(ELBWI).Methods We searched PubMed,Cochrane Library,EMBASE,Wanfang,CNKI and VIP database for literature from the establishment of the database to December 2019.Randomized and quasi-randomized controlled trials of the effects of HFOV and CMV on VLBWI and ELBWI were included.The data were analyzed by RevMan 5.2.7 software.Results The results of the Meta-analysis of 12 articles showed that compared with the CMV group,HFOV group had shorter ventilation time(MD=-32.27,P=0.001),and the incidence of bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP)(≥2 stage)decreased(RR=0.74 and 0.80,respectively,both P<0.05),and the incidence of air leak syndromes,intraventricular hemorrhage(IVH)(grade 3 or 4)and periventricular leukomalacia(PVL)were not statistically significant(RR=1,P=0.97;RR=1,P=0.98;RR=0.79,P=0.16).Conclusions HFOV can reduce the risk of BPD and ROP(stage 2 or greater)and does not affect the occurrence of IVH(grade 3 or 4)and PVL,but its long-term effects on pulmonary function and nervous system development still need further research.