肺表面活性物质治疗新生儿胎粪吸入综合征的系统评价  

Systematic review of pulmonary surfactant for meconium aspiration syndrome

作　　者：杨彤[1] 沈琪[1] 黄献文[1] 

机构地区：[1]广西医科大学第五附属医院儿科,广西柳州545006

出　　处：《中国实用儿科杂志》2010年第3期220-226,共7页Chinese Journal of Practical Pediatrics

摘　　要：目的评价肺表面活性物质(PS)治疗新生儿胎粪吸入综合征(MAS)的疗效和安全性。方法检索Cochrane图书馆、PubMed、EMBASE、CBMdisc、CNKI、VIP等,检索时间均从建库至2008-12-31,对同质资料进行Meta分析。结果共纳入11项研究(605例)。Meta分析结果示:(1)PS与安慰剂或空白对照,病死率、气胸发生率、气漏发生率、慢性肺疾病发生率、脑室内出血发生率、机械和辅助通气供氧天数差异均无统计学意义,住院天数和需要人工体外膜氧合法差异有统计学意义。(2)应用机械通气联合PS与机械通气对照,病死率、气漏发生率、机械及通气供氧天数、住院天数、治疗后12h和24h氧合指数(OI)及动脉/肺泡氧分压比值(a/APO2)差异有统计学意义;但脑室内出血发生率、OI(治疗前)和a/APO(2治疗前)差异均无统计学意义。结论PS的疗效及安全性并不优于安慰剂或空白对照;机械通气联合PS的疗效和安全性要优于机械通气,由于纳入研究存在偏倚的可能性,有必要进一步开展高质量随机对照试验,评价其疗效和安全性。Objective To assess the effect and safety of pulmonary surfactant for meconium aspiration syndrome. Methods We searched the data of the Cochrane library .PUBMED .EMBASE .CBMdise .CNKI .VIP from the time of es- tablishment to 31 December 2008, and assessed the quality of included studies, extracted data and meta-analysis for the result of homogenous studies. Results Eleven studies involving 605 participants were included, Four studies were grad- ed A, the other seven graded C. Meta-analysis based on included studies showed ： （ 1 ） Pulmonary surfactant vs placebo or no therapy： mortality, pneumothorax, air leaks, chronic lung disease, intraventricular hemorrhage, duration of assisted mechanical ventilation （days）and duration of supplemental oxygen （days） all had no statistically significant difference; duration of hospital stay （days） and treatment with ECMO had statistically significant difference. （2） Pulmonary surfactantand mechanical ventilation vs mechanical ventilation： mortality, air leaks, duration of assisted mechanical ventila- tion （days）, duration of supplemental oxygen （days）, duration of hospital stay （days）, OI （ 12 h, 24 h ） and a/A P02（ 12 h, 24 h） all had statistical significance; intraventricular hemorrhage, OI （0 h） and a/A PO2 （0 h） had no statistical significance. Conclusion Available evidence shows ： compared with placebo or no therapy, the pulmonary surfactant can＇ t improve the effect and safety of MAS ; compared with mechanical ventilation, pulmonary surfactant and mechanical yen- tilation can improve the effect and safety of MAS ; due to the bias, it is necessary to develop the contrast experiment with higher quality and larger scale clinical trials to evaluate its effectiveness and safety.

关 键 词：新生儿 肺表面活性物质 胎粪吸入综合征 系统评价 

分 类 号：R72[医药卫生—儿科]