俯卧位通气治疗新生儿呼吸窘迫综合征并发症风险的Meta分析

The Complications Risk of Prone Position Ventilation Treating Neonatal Respiratory Distress Syndrome:A Meta-analysis

目的探讨俯卧位通气(prone position ventilation,PPV)对新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)并发症风险发生的影响。方法由两位研究者确定检索方法和纳入标准,分别对PubMed、EMBASE、Web of Science、中国生物医学文献数据库、中国知网、万方和维普等数据库中PPV对NRDS机械通气患儿影响的相关文献进行检索。从中筛选出符合纳入标准的文献,进行质量等级划分和提取有用的信息资料,最后运用RevMan 5.3软件进行循证医学分析。结果最终符合纳入标准的研究有12项,涵盖1246例研究对象。Meta分析的结果表明:仰卧位组在压疮、意外拔管、呼吸机相关性肺炎、气胸、肺出血、皮下水肿、颅内出血风险的发生率均高于间断PPV组(P≤0.05);两组在人工气道堵塞风险发生率方面无明显差异(P>0.05)。结论PPV可降低NRDS患儿压疮、意外拔管、呼吸机相关性肺炎、气胸、肺出血、皮下水肿、颅内出血风险的发生率,但并不影响人工气道堵塞风险的发生率,可为新生儿科开展PPV工作的安全性提供相应的证据参考。

Objective To discuss the influence of prone position ventilation(PPV)on the complications risk of neonatal respiratory distress syndrome(NRDS).Methods The two researchers jointly formulated retrieval strategies and inclusion criteria.Relevant clinical controlled trials on the application effect of PPV on NRDS mechanical ventilation in newborns were searched from PubMed,EMBASE,Web of Science,China Biomedical Literature Database,CNKI,Wanfang,and VIP databases,respectively.The literature that met the inclusion criteria was screened out,the quality grade was divided,and valuable information was extracted.Finally,RevMan 5.3 software was used for evidence-based medicine analysis.Results 12 pieces of literature ultimately met the inclusion criteria,covering 1246 subjects.The Meta-analysis results showed that the risk of pressure ulcers,accidental extubation,ventilator-associated pneumonia,pneumothorax,pulmonary hemorrhage,subcutaneous edema,and intracranial hemorrhage in the supine group was higher than those in the PPV group(P≤0.05).There was no significant difference in the risk of artificial airway blockage between the two groups(P>0.05).Conclusion PPV can reduce the risk of pressure ulcers,accidental extubation,ventilator-associated pneumonia,pneumothorax,pulmonary hemorrhage,subcutaneous edema,and intracranial hemorrhage in newborns with NRDS,but does not affect the risk of artificial airway blockage.This study can provide evidence reference for the safety of PPV in neonatology.