彭万胜 1陈信 1杨小云 1诸宏伟 1王磊 1刘恩梅2
作者信息
- 1. 安徽省蚌埠医学院第一附属医院儿科,蚌埠市,233004
- 2. 重庆医科大学附属儿童医院,呼吸科,重庆,400014
- 折叠
摘要
Abstract
Objective To assess prophylactic nasal continuous positive airways pressure ( CPAP ) used soon after birth regardless of respiratory status in infants who were preterm or with very low birth weight to reduce the use of mechanical ventilation ( MV ) and the incidence of respiratory distress syndrome( RDS ) , bronchopulmonary dysplasia( BPD ) and adverse outcomes of nasal CPAP. Methods We searched the Cochrane Central Register of Controlled Trials ( CENTRAL), EMBASE, PubMed, CNKI, Wanfang Chinese periodical Database and VIP Chinese periodical Database from the establishment of the database to December 2011, using the terms ( prophylactic nasal CPAP OR early nasal CPAP ) AND ( preterm infants OR low birth weight infants). All trials using randomized or quasi-randomized patient allocation of preterm infants ≤ 32 weeks gestation were eligible. Two review authors independently assessed the potential risk of bias in included studies according to the Cochrane Collaboration's recommendations including sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting and other sources of bias. Risk ratios ( RR) and 95% confidence intervals ( CI) as the effect measures for dichotomous data were synthesized. The mean difference ( MD ) and 95% CI were used as the metrics of effect size for continuous outcomes. The meta-analysis was performed using the Cochrane statistical package RevMan 5. 0. Results Eight trials in preterm infants who were treated with prophylactic nasal CPAP were included. NCPAP group failed to significantly reduce the utilization rate of tracheal intubation(RR = -0.09,95% CI: -0. 19-0.02,P =0.09 ), incidence of RDS( RR =0. 81,95%CI:0. 59 - 1. 1 ,P =0. 18 ) and fatality ( RR = 0. 88,95% CI:0. 72 - 1. 09, P = 0. 25 ) in preterm infants. The use of prophylactic nasal CPAP resulted in a reduction in the outcome of surfactant administration ( RR=0.72, 95% CI: 0.64-0.80, P<0.000 01 ). NCPAP group failed to significantly reduce the time of tracheal intubation ( MD = - 1.91 d, 95% CI: -6.47 - 4.45 d, P = 0.72 ) and the time of oxygen ( MD= -0.46 d,95%CI: -6.55 -5.63 d,P = 0.88 ). There were no statistically significant differences in the incidence of BPD, IVH, retinopathy of prematurity, necrotizing enterocolitis, and ROP between NCPAP group and control group. Conclusions Recent evidences indicate significant effects of prophylactic nasal CPAP in reducing the outcome of surfactant administration and increasing the incidence of pneumothorax. Further multi-center randomized controlled trials are still expected to evaluate the effectiveness of prophylactic nasal CPAP for reducing the incidence of RDS, death and increasing the incidence of some adverse outcomes.关键词
经鼻持续气道正压通气/早产儿/低出生体重儿/预防/呼吸窘迫综合征/Meta分析Key words
Nasal continuous positive airways pressure/Preterm infants/Very low birth weight infants/Preventing/Respiratory distress syndrome/Meta analysis
