早期经气管内滴入布地奈德联合肺表面活性物质预防支气管肺发育不良有效性与安全性的Meta分析

Meta-analysis of efficacy and safety of early intratracheal instillation budesonide combined with pulmonary surfactant in the prevention of bronchopulmonary dysplasia

目的评估早期经气管内滴入布地奈德联合肺表面活性物质预防支气管肺发育不良(bronchopulmonary dysplasia,BPD)的有效性和安全性。方法检索Embase、PubMed、Cochrane图书馆、中国知网及万方数据库,检索时间为建库至2022年2月,根据文献纳入和排除标准进行文献筛选、质量评估及资料提取,采用Rev Man 5.3软件对纳入文献进行Meta分析。结果本研究纳入9篇随机对照研究文献,合计884例患儿,其中实验组433例,对照组451例。结果显示,两组BPD发生率比较差异有统计学意义[OR=0.40,95%CI(0.29,0.53),P<0.001],两组病死率比较差异无统计学意义[OR=0.65,95%CI(0.34,1.22),P=0.18],实验组发生早产儿视网膜病变[OR=0.42,95%CI(0.54,1.28),P=0.40]、动脉导管未闭[OR=0.79,95%CI(0.57,1.10),P=0.17]、颅内出血[OR=1.09,95%CI(0.77,1.53),P=0.63]、坏死性小肠结肠炎[OR=0.89,95%CI(0.55,1.44),P=0.64]、新生儿败血症[OR=0.73,95%CI(0.49,1.08),P=0.11]的风险与对照组相比,差异均无统计学意义(P均>0.05)。结论生后早期经气管内滴入布地奈德联合肺表面活性物质预防可明显降低BPD发生率,且对病死率及短期并发症无明显影响。

Objective To evaluate the efficacy and safety of early intratracheal drops of budesonide combined with pulmonary surfactant in the prevention of bronchopulmonary dysplasia(BPD).Methods Embase,PubMed,Cochrane Library,CNKI and Wanfang database were searched from the establishment of library construction to February 2022.Literature selection,quality assessment and data extraction were conducted according to the inclusion and exclusion criteria,and Meta-analysis was performed on the included literature using Rev Man 5.3 software.Results Nine randomised controlled studies were included in this study,with a total of 884 children,including 433 in the experimental group and 451 in the control group.The results showed that there was a statistically significant difference in the incidence of BPD between the two groups[OR=0.40,95%CI(0.29,0.53),P<0.001],and there was no statistically significant difference in the morbidity between the two groups[OR=0.65,95%CI(0.34,1.22),P=0.18].The risks of retinopathy of prematurity[OR=0.42,95%CI(0.54,1.28),P=0.40],patent ductus arteriosus[OR=0.79,95%CI(0.57,1.10),P=0.17],intracranial hemorrhage[OR=1.09,95%CI(0.77,1.53),P=0.63],necrotizing enterocolitis[OR=0.89,95%CI(0.55,1.44),P=0.64],and neonatal septicemia[OR=0.73,95%CI(0.49,1.08),P=0.11]occurred in the experimental group had no statistically significant differences compared to the control group(allP>0.05).Conclusion Early postnatal intratracheal drops of budesonide combined with pulmonary surfactant can significantly reduce the incidence of BPD,and has no significant effect on mortality or short-term complications.