亚低温治疗新生儿缺血缺氧脑病疗效及远期预后的Meta分析  

Efficacy and long term prognosis of hypothermia for treating neonatal hypoxic ischemic encephalopathy:a Meta analysis

作　　者：刘鹏[1] 何珊 左泽兰[1] LIU Peng;HE Shan;ZUO Zelan(Department of PICU,Children′s Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院重症医学科/儿童发育疾病研究教育部重点实验室/儿童发育重大疾病国家国际科技合作基地/儿科学重庆市重点实验室

出　　处：《重庆医学》2020年第5期796-801,共6页Chongqing medicine

基　　金：重庆市科委应用与开发项目（cstc2013yykfA110008）

摘　　要：目的系统评价国内外亚低温治疗新生儿缺血缺氧脑病(HIE)相关研究,评价亚低温治疗HIE的疗效及远期预后。方法计算机检索建库至2019年1月发表于中国生物医学文献数据库、中国知网、维普、万方数据库、Pubmed、Embase、Ovid、Springer、Cochrane图书馆中关于亚低温治疗HIE的临床随机对照研究(RCT)。采用RevMan 5.0软件对满足纳入标准的RCT文献进行Meta分析。以随访8个月至7年患儿病死率、严重神经系统发育障碍[脑瘫、癫痫、视力损害、听力损害、心理运动发育指数(PDI)<70分、智力发育指数(MDI)<70分]发生率作为观察指标,进行定性和定量综合评估。结果共检索到704篇文献,符合纳入标准的文献13篇。Meta分析结果显示,亚低温组和对照组比较病死率显著降低(RR=0.67,95%CI:0.59~0.77);随访6个月至7年时严重神经系统缺陷发生率显著降低(RR=0.55,95%CI:0.43~0.71);脑瘫发生率显著降低(RR=0.55,95%CI:0.41~0.73);PDI<70分发生率显著降低(RR=0.65,95%CI:0.43~0.97);但癫痫发生率、视力损害发生率、听力损害发生率、MDI<70分发生率差异无统计学意义(P>0.05)。结论亚低温治疗能显著降低HIE病死率,改善患儿6个月至7年的远期预后,减少严重神经系统发育障碍的发生率。Objective To systematically evaluate the related studies of neonatal hypoxia-ischemic encephalopathy(HIE)and to evaluate the effects and long term prognosis of hypothermia in treating HIE.Methods The clinical randomized controlled trials(RCTs)on hypothermia for treating HIE published in the China Biology Medicine disc,WANGFANG Data,CNKI,VIP,PubMed,EMBASE,Ovid,Springer and Cochrane library were retrieved by computer from their database establishment to January 2019.The RCT literatures meeting the inclusion standard conducted the meta analysis by adopting RevMan5.0 software.The observation indicators included the fatality rate,and incidence rates of severe neural system defect after follow up for 6 months to 7 years development disorder,cerebral palsy,epilepsy,visual impairment,hearing impairment,psychomotor developmental index(PDI)<70 points and mental development index(MDI)<70 points.The qualitative and quantitative comprehensive evaluation was performed.Results A total of 704 articles were retrieved out,13 articles met the inclusion standard.The meta analysis results showed that the fatality rate in the hypothermia group was significantly decreased compared with the control group(RR=0.67,95%CI:0.59-0.77),the occurrence rate of severe neural system defect after follow up for 8 months to 7 years was significantly decreased(RR=0.55,95%CI:0.43-0.71);the occurrence rate of cerebral palsy was significantly decreased(RR=0.55,95%CI:0.41-0.73),the occurrence rate of PDI<70 points was significantly decreased(RR=0.65,95%CI:0.43-0.97).However,the occurrence rates of epilepsy,visual impairment,hearing impairment and MDI<70 points had no statistical differences(P>0.05).Conclusion Hypothermia can significantly decrease the fatality rate of HIE,improve the long term prognosis from 6 months to 7 years,and decrease the occurrence rates of severe neural system developmental disorder.

关 键 词：亚低温治疗 缺血缺氧脑病 META分析 新生儿 

分 类 号：R272.1[医药卫生—中医儿科学]