米力农治疗新生儿持续性肺动脉高压的Meta分析

Milinone for the Treatment of Persistent Pulmonary Hypertension in Newborns:a Meta Analysis

目的系统评价米力农治疗新生儿持续性肺动脉高压(persistent pulmonary hypertension of the newborn,PPHN)的疗效和安全性。方法检索PubMed、The Cochrane Library、Embase、SinoMed、中国知网、万方、中国科技期刊数据库建库至2020年9月1日的文献,收集关于米力农治疗新生儿PPHN的随机对照试验。采用Revman 5.3软件对结局指标进行Meta分析。结果最终纳入9篇文献,包括920例新生儿。Meta分析结果显示:与常规治疗相比,加用米力农能提高治疗有效率(91.7%vs.73.1%;OR=1.25,95%CI:1.15~1.36,P<0.00001),减少机械通气时间(MD=-23.65,95%CI:-35.09~-12.21,P<0.001),升高血氧饱和度(MD=11.30,95%CI:3.86~18.74,P=0.003)和氧分压(MD=9.40,95%CI:2.33~16.46,P=0.009),降低肺动脉收缩压(MD=-10.35,95%CI:-13.24~-7.47,P<0.00001),且差异均具有统计学意义。结论现有证据表明,米力农可以提高新生儿PPHN的治疗有效率,减少机械通气时间,升高血氧饱和度和氧分压以及降低肺动脉收缩压,但由于现有研究随访时间有限,米力农治疗新生儿PPHN的安全性尚不明确,有待进一步证实。

Objective To evaluate the efficacy and safety of milrinone in the treatment of persistent pulmonary hypertension in newborns.Methods PubMed,Cochrane Library,EMbase,CNKI,China biomedical literature database,Wanfang database and China scientific and technological journal database(Weipu)were searched for RCTs about PPHN treated with milrinone in newborns published up to Sep 1,2020.Review Manager 5.3 software was used for statistical analysis.Results A total of 9 RCTs with 920 neonates were included.The results of the Meta analysis showed that,compared with conventional therapy,milrinone could significantly improve the treatment response rate(91.7%vs.73.1%;OR=1.25,95%CI:1.15~1.36,P<0.00001),reduce mechanical ventilation time(MD=-23.65,95%CI:-35.09~-12.21,P<0.001),increase blood oxygen saturation(MD=11.30,95%CI:3.86~18.74,P=0.003)andoxygen partial pressure(MD=9.40,95%CI:2.33~16.46,P=0.009),decrase pulmonary artery systolic blood pressure(MD=-10.35,95%CI:-13.24~-7.47,P<0.00001),and the differences were statistically significant.Conclusion Milrinone can improve the therapeutic efficiency of neonatal PPHN,reduce mechanical ventilation time,increase blood oxygen saturation and oxygen partial pressure,and reduce pulmonary arterial systolic pressure.However,the safety of milrinone in the treatment of neonatal PPHN is still unclear and needs to be further confirmed.