中国循证儿科杂志2011，Vol.6Issue(4)：255-263,9.DOI:10.3969/j.issn.1673-5501.2011.04.004
经鼻间歇和持续气道正压通气治疗新生儿呼吸窘迫综合征的Meta分析
The effect of nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure in neonatal respiratory distress syndrome: a meta-analysis
摘要
Abstract
ovjective To compare the efficacy of nasal intermittent positive pressure ventilation ( NIPPV ) versus nasal continuous positive airway pressure ( NCPAP ) in neonatal respiratory distress syndrome ( NRDS ).Methods Standard literature search strategy for the Cochrane Neonatal Review Group was performed.Searches were made in PubMed.EMBASE , Ovid, Springer and CNKI databases with the terms of newborn OR preterm AND respiratory distress syndrome AND nasal intermittent positive pressure ventilation AND nasal continuous positive airway pressure.Only RCTs or quasi-RCTs which involved NIPPV versus NCPAP were included and the rate of endotracheal ventilation, successful extubation, outcome as well as the condition of apnea of prematurity, the incidence of bronchopulmonory dysplasia ( BPD ).retinopathy of prematurity( ROP ) , intraventricular hemorrhage ( IVH ) and periventricular leukomalacia ( PVL ), and length of stay were taken as the observation items.Results A total of 103 literatures were reviewed.Thirteen eligible randomized controlled trials were included.The results of quality assessment showed that 13 studies described the method of random allocation.Twelve studies mentioned allocation concealment and 2 studies did not use blinding method for participants.Included studies had no significant difference in regard to baseline when enrolled.In the meta-analysis of trial data.as compared with NCPAP.NIPPV significantly reduced the incidence of endotracheal ventilation ( OR = 0.39.95％ CI:O.23 - 0.56.P ＜ 0.000 01 ), increased the successful rate of extubation ( OR = 0.15.95％ CI:O.08 - 0.31.P ＜0.000 01 ), and had a better outcome ( OR = 0.30.95％ CI:O.13 - 0.68.P = 0.004 ).Moreover, as compared with NCPAP,NIPPV improved apnea of prematurity ( WMD = -0.48.95％ CI: - 0.58 - - 0.37.P ＜ 0.000 01 ).decre.ased the incidence of ROP ( OR = 0.36.95％ CI:0.15 - 0.87 , P = 0.02 ), but there was no significant incidence reduction in BPD ( OR = 0.59 , 95％ CI:O.29 -1.16 ).IVH and PVL( OR =0.54, 95％ CI:0.24 - 1.20 ), or length of stay ( WMD = - 2.97, 95％ CI: - 11.26 5.32 ).Conclusions In the treatment of NRDS.NIPPV significantly reduced entracheal ventilation, increased successful extubation, improved apnea of prematurity, decreased the incidence of ROP, and had better outcome as compared with NCPAP.However.there was no evidence supporting that NIPPV could reduce the incidence of BPD.IVH and PVL.Larger sample size RCTs are needed to investigate the long-term efficacy of NIPPV in neonatal respiratory intensive care.关键词
新生儿/呼吸窘迫综合征/经鼻间歇正压通气/经鼻持续气道正压通气/Meta分析Key words
Newborn infant/ Respiratory distress syndrome/ Nasal intermittent positive pressure ventilation/ Nasal continuous positive airway pressure / Meta-analysis引用本文复制引用
唐仕芳,赵锦宁,沈洁,胡章雪,史源..经鼻间歇和持续气道正压通气治疗新生儿呼吸窘迫综合征的Meta分析[J].中国循证儿科杂志,2011,6(4):255-263,9.基金项目
省部共建国家教育部重点实验室开放基金:EYKF200901 （）
第三军医大学临床科研基金:2009 （）
第三军医大学附属大坪医院野战外科研究所1135人才项目:2009 （）
