不同浓度氧气复苏窒息极早产儿的系统评价  

Resuscitation of asphyxiated extreme preterm infants with room air or oxygen: a systematic review

作　　者：余章斌[1] 沙莉[1] 韩树萍[1] 陈玉林[1] 邱玉芳[1] 

机构地区：[1]南京医科大学附属南京妇幼保健院儿科,210004

出　　处：《中国新生儿科杂志》2011年第5期343-348,共6页Chinese Journal of Neonatology

基　　金：南京市医学科技发展基金(YKK10038)

摘　　要：目的探讨不同浓度氧气复苏窒息极早产儿的临床效果。方法通过文献检索收集不同浓度氧气复苏窒息极早产儿的随机对照试验，采用RevMan5．0分析软件，首先进行异质性检验，当结果不存在异质性，以固定效应模型描述，存在异质性时，以随机效应模型表达，将资料进行定量综合，采用比值比（OR）及其95％可信区间（95％CI）表示。结果共6篇文献符合条件纳入研究，其中4篇文献为B级，2篇文献为C级。累计低浓度氧（21％～50％）复苏组157例，高浓度氧（90％～100％）复苏组168例。不同氧浓度复苏对极早产儿复苏失败率（OR＝2．03，95％CI：0．87～4．71）和病死率（OR=1．23，95％CI：0．53～2．86）无影响，对支气管肺发育不良（OR=1．07，95％CI：0．55～2．10）、颅内出血（OR=1．99，95％CI：0．76—5．23）、败血症（OR=1．00，95％CI：0．46～2．17）、早产儿视网膜病（OR=0．71，95％CI：0．18～2．73）、气胸（OR=0．28，95％CI：0．04～1．82）、动脉导管未闭（OR=0．74，95％CI：0．34～1．64）的发生率均无影响（P均〈0．05）。结论不同浓度氧气复苏窒息极早产儿的效果无差异，但由于纳入文献质量有限，对于复苏开始的氧浓度、如何调整氧浓度、安全的血氧饱和度范围等问题仍需进一步大样本随机对照试验进行评价。Objective To investigate the optional resuscitation oxygen concentration for asphyxiated extreme preterm infants based on a systemic review of the published studies which compared the effects of resuscitation of asphyxiated extreme preterm infants with room air versus oxygen and thus provide a high-quality evidence-based clinical practice. Methods We performed a randomized controlled trials which compared the effects of resuscitation of asphyxiated extreme preterm infants with room air versus oxygen, extracted data of the included studies. Statistical analysis was performed by using Rev Man 5.0. Heterogeneity of the included articles was used to select the proper effect model. The calculation methods of the merged odds ratio （OR） and 95% confidence interval （CI） were determined. Results Six studies （157 infants with low oxygen concentration and 168 infants with high oxygen concentration） were included. Four studies were graded as B, two studies were graded as C. Results from Meta-analysis demonstrated that there was no difference in the rate of resuscitation failure （ OR = 2.03, 95% CI： 0.87-4.71）, the risk of neonatal mortality （OR=1.23, 95% CI： 0.53-2.86）,bronchopulmonary dysplasia （OR = 1.07, 95% CI： O. 55 -2. 10） , intraventrieular hemorrhage （ OR = 1.99, 95% CI： 0.76 -5.23） , septicemia （OR = 1.00, 95% CI： 0. 46 -2. 17） between low and high oxygen concentration group. A trend toward a decrease in the risk of retinopathy of prematurity （ OR = 0. 71, 95% CI： 0. 18- 2.73）, pneumothorax （OR =0.28, 95% CI： O. 04- 1.82）, patent ductus arteriosus （OR =0.74, 95% CI： O. 34- 1.64） was noted with resuscitation in low concentration group compared to the high oxygen concentration group. Conclusion As the limited number of studies and sample sizes, some issues still need be evaluated by performing further larger scale randomized controlled trials, such as： the most appropriate oxygen concentration of starting resuscitation, the satest oxygen saturation range an

关 键 词：空气 氧气 出生窒息 复苏 系统评价 

分 类 号：R722.6[医药卫生—儿科]