高压氧治疗新生儿缺氧缺血性脑病的临床疗效研究:中文文献的系统性综述  

Clinical effectiveness of treatment with hyperbaric oxygen for neonatal hypoxic-ischaemic encephalopathy: systematic review of Chinese literature

作　　者：刘祖联[1] 熊滕宾[1] Catherine Meads 杨群（译） 孙波 

机构地区：[1]公共卫生与流行病学系伯明翰大学,伯明翰大学Birminsham B15 2TT英国 [2]director of masters degree in health technology assessment [3]不详

出　　处：《英国医学杂志中文版》2006年第4期212-215,共4页The BMJ Chinese Edition

摘　　要：目的研究高压氧治疗新生儿缺氧缺血性脑病的临床疗效。这种治疗在中国使用较多而在西方国家非常少。数据来源对西方国家(以Cochrane文献资料库登录的临床对照试验及系统性综述数据库,Medline,Embase, CINAHL和HealthSTAR)和中国(中国医院数字图书馆,中华医学网络杂志)的数据库以及人工检索中国杂志。不设语种限制。综述方法随机或准随机对照试验比较高压氧与“常规治疗”在治疗足月儿缺氧缺血性脑病的疗效。结果包括死亡率和长期神经系统后遗症。标准表格用于提取和分析数据。约克评述与传播中心的标准用于质量评估。主要是定性分析,但包括荟萃分析。结果共检索到20个试验,主要来自中国。根据西方标准(CONSORT:国际学术期刊发表多中心临床试验论文撰写标准),试验的质量较差。几乎所有的研究表明高压氧治疗组较对照组有更好的结果。荟萃分析显示死亡率的比值比(odds ratio)为0．26(95％可信区间0．14～0．46),神经系统后遗症的比值比为0．41(0．27～0．61)。结论高压氧治疗可能会减少足月新生儿缺氧缺血性脑病死亡率和神经系统后遗症的发生。由于所有试验研究的质量均较差,同时可能存在发表带来的偏倚,因此需要进行足够有说服力的、高质量的随机对照研究来证实这些发现。中国的医学文献可能是影响临床实践和进行其他系统性综述的丰富的证据来源。Objectives To investigate the clinical effectiveness of treatment with hyperbaric oxygen for neonates with hypoxic-ischaemic encephalopathy. This treatment is frequently used in China but much less often in the West. Data sources Western （ Cochrane controlled trials register and database of systematic reviews, Medline, Embase, CINAHL, and HealthSTAR） and Chinese （China Hospital Digital Library, Chinese Medical Journal Network ） databases and hand search of Chinese journals. No language restrictions. Review methods Randomised or quasi- randomised controlled trials of treatment with hyperbaric oxygen compared with ＂ usual care＂ in term neonates with hypoxic-ischaemic encephalopathy. Outcomes included mortality and long term neurological sequelae. Standardised forms were used to extract and compare data. Criteria of York Centre for Reviews and Dissemination were used to assess quality. Analysis was mainly qualitative but included meta-analysis. Results 20 trials were found, mainly from Chinese sources. The reporting quality of trials was poor by Western （CONSORT） standards. Treatment with hyperbaric oxygen had better outcomes than the comparator in almost all trials. The odds ratios of the meta-analyses were 0.26 （95% confidence interval 0.14 to 0.46 ） for mortality and 0.41 （ 0.27 to 0. 61 ） for neurological sequelae. Conclusion Treatment with hyperbaric oxygen possibly reduces mortality and neurological sequelae in term neonates with hypoxic-ischaemic encephalopathy. Because of the poor quality of reporting in all trials and the possibility of pubheation bias, an adequately powered, high quality randomised controlled trial is needed toinvestigate these findings. The Chinese medical literature may be a rich source of evidence to inform clinical practice and other systematic reviews.

关 键 词：新生儿缺氧缺血性脑病 临床疗效研究 高压氧治疗 系统性综述 中文文献 神经系统后遗症 临床对照试验 COCHRANE 随机对照试验 Medline 

分 类 号：R722.1[医药卫生—儿科]