呼吸衰竭新生儿应用高频振荡通气的循证医学研究  

Evidence-Based Medicine Study Suggestion on High Frequency Oscillatory Ventilation in Neonates

作　　者：王华[1] 母得志[1] 熊英[1] 

机构地区：[1]四川大学华西第二医院新生儿科,四川成都610041

出　　处：《中华妇幼临床医学杂志（电子版）》2010年第6期415-419,共5页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

摘　　要：目的系统评价(systematic evaluation)高频振荡通气(high frequency oscillatory ventilation,HFOV)在呼吸衰竭新生儿的使用价值。方法采用循证医学方法,检索1983年1月1日至2009年12月31日,Medline,EMBASE,中国循证医学/Cochrane中心数据库文献中有关高频振荡通气和常频通气(conventional ventilation,CV)的文献19篇(均为英文文献),其中17篇为早产儿(胎龄<34孕周)或低出生体重(low birth weight,LBW,产重<2000 g)儿使用HFOV亚组1与CV亚组1的比较,共纳入受试患儿3652例;另外2篇为足月及近足月儿选择性、解救性使用HFOV亚组2与CV亚组2的比较,共纳入受试患儿197例。采用Meta分析法对研究文献进行系统评价,比较两种通气方式治疗新生儿呼吸衰竭的有效性。结果在早产儿或低出生体重儿中,HFOV亚组1和CV亚组1(28～30)d龄新生儿中,死亡率、颅内出血(intracranial hemorrhage,ICH)及脑室周围白质软化(periventricular leukomalacia,PVL)、气漏发生率比较,差异无显著意义(P>0.05),HFOV组支气管肺发育不良(bronchopulmonary dysplasia,BPD)发生率有降低(P<0.05),早产儿视网膜病(retinopathy of prematurity,ROP)发生率降低(P<0.05)。在足月儿和近足月儿中,HFOV亚组2和CV亚组2新生儿中,生后28 d死亡率、气漏发生率、支气管肺发育不良、颅内出血及脑室周围白质软化发病率比较,差异无显著意义(P>0.05)。结论现有的循证医学证据表明,由于各种疾病所致新生儿呼吸衰竭时,选择高频振荡通气并不比常频通气模式有十分明显的优势。Objective Most of diseases which cause neonatal respiratory failure could use high frequency oscillatory ventilation （HFOV） or conventional ventilation （CV） to treat, but till now, it is unclear which is better. In this article, from the view of evidence-based medicine （EBM）, we evaluate the effectiveness of high frequency oscillatory ventilation on the treatment of neonatal respiratory failure. Method We collected relative articles from Medline, EMBASE, Cochrane data base during January 1, 1983 to December 31, 2009, and then conducted systematic evaluation between high frequency oscillatory ventilation or conventional ventilation among preterm,low birth weight（LBW） infants （HFOV sub-group 1 and CV sub group 1）, term and near term infants （ HFOV sub group 2 and CV sub-group 2）. Results Among preterm and low birth weight infants, there was no significant difference of incident rate of mortality, intracranial hemorrhage （ICH）, periventricular leukomalacia （PVL）, pneumothorax between HFOV sub-group 1 and CV sub-group 1 （P〉0.05） during 28-30 clays after birth. In HFOV sub group 1, the incident rates of chronic lung disease （CLD） and retinopathy were obviously lower （P〈0.05）. As for term and near term infants, there still was no significant difference of mortality, pneumothorax, chronic lung disease, intracranial hemorrhage and periventricular leukomalacia rate between HFOV sub-group 2 and CV sub group 2. Conclusion The existing evidence-based medicine can not show that high frequency oscillatory ventilation is much better than conventional ventilation in newborn respiratory failure.

关 键 词：高频振荡通气 常频通气 新生儿呼吸衰竭 Meta分析 

分 类 号：R722.1[医药卫生—儿科]