西地那非治疗新生儿持续性肺动脉高压的系统评价  

Sildenafil in the Treatment of Peristent Pulmonary Hypertension in Newborns:A Systematic Review

作　　者：蒋璐灿 全淑燕 李佳莲[1,2,3,4] 归舸 石晶[5] 张伶俐[2,3,4] 

机构地区：[1]四川大学华西药学院,成都610041 [2]四川大学华西第二医院药学部,成都610041 [3]四川大学华西第二医院循证药学中心,成都610041 [4]出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [5]四川大学华西第二医院儿科教研室,成都610041

出　　处：《中国药房》2017年第9期1211-1215,共5页China Pharmacy

基　　金：国家自然科学基金资助项目(No.81373381)

摘　　要：目的:系统评价西地那非治疗新生儿持续性肺动脉高压(PPHN)的临床疗效,为临床提供循证参考。方法:计算机检索Pub Med、Cochrane图书馆、EMBase(Ovid)、中国生物医学文献数据库、中国期刊全文数据库、万方数据库和中文科技期刊数据库,收集西地那非(试验组)对比基础治疗或安慰剂治疗PPHN的随机对照试验(RCT),对符合纳入标准的临床研究进行资料提取,并参考Cochrane系统评价员手册5.1.0进行质量评价,然后采用Rev Man 5.1统计软件进行Meta分析。结果:共纳入6项RCT,合计210例患儿。Meta分析结果显示,与安慰剂比较,西地那非治疗PPHN可以显著降低患儿的病死率[RR=0.16,95%CI(0.05,0.45),P<0.001]和氧合指数[2 h后:MD=-12.80,95%CI(-20.11,-5.49),P<0.001;24 h后:MD=-19.41,95%CI(-24.81,-14.00),P<0.001],差异均有统计学意义;与基础治疗比较,西地那非治疗PPHN可以显著降低患儿肺动脉压[2 h后:MD=-22.36,95%CI(-24.89,-19.83),P<0.001;24 h后:MD=-29.43,95%CI(-31.12,-27.74),P<0.001],差异均有统计学意义,但对病死率无显著影响[RR=0.64,95%CI(0.30,1.39),P=0.26]。结论:西地那非治疗PPHN疗效较好,可以显著降低患儿的氧合指数、肺动脉压和病死率。OBJECTIVE：To systematically review the clinical efficacy of sildenafil in the treatment of persistent pulmonary hypertension in newborns（PPHN）,and to provide evidence-based reference in the clinic. METHODS：Retrieved from Pub Med,Cochrane Library,EMBase（Ovid）,CBM,CJFD,Wanfang and VIP,randomized controlled trials（RCTs）about sildenafil（test group）versus basic therapy or placebo in the treatment of PPHN were collected. Meta-analysis was performed by using Rev Man 5.1 software after data extraction and quality evaluation by Cochrane 5.1.0. RESULTS：Totally 6 RCTs were enrolled,involving 210 patients. Results of Meta-analysis showed,compared with placebo,sildenafil can significantly reduce the mortality [RR=0.16,95%CI（0.05,0.45）,P〈0.001] and the oxygenation index [after 2 h：MD=-12.80,95%CI（-20.11,-5.49）,P〈0.001;after 24 h：MD=-19.41,95%CI（-24.81,-14.00）,P〈0.001],with statistical significances;compared with basic therapy,sildenafil can significantly reduce pulmonary arterial pressure [after 2 h：MD=-22.36,95%CI（-24.89,-19.83）,P〈0.001;after 24 h：MD=-29.43,95%CI（-31.12,-27.74）,P〈0.001],with statistical significances,but there was no statistical difference in mortality[RR=0.64,95%CI（0.30,1.39）,P=0.26]. CONCLUSIONS：Sildenafil is effective in the treatment of PPHN,it can significantly reduce the oxygenation index,pulmonary arterial pressure and mortality.

关 键 词：西地那非 持续性肺动脉高压 META分析 新生儿 疗效 

分 类 号：R722.19[医药卫生—儿科]