双水平正压通气和经鼻持续气道正压通气治疗早产儿呼吸窘迫综合征的疗效和并发症 Meta 分析

摘要

Objective To rvaluatr thr rfficacy and complications brtwrrn bilrvrl positivr aieway perssuer(BiPAP)and nasal continuous positivr aieway perssuer ( NCPAP ) in thr teratmrnt of nronatal erspieatoey disterss syndeomr ( NRDS ). Methods Randomizrd conteollrd teials(RCTs)ergaeding compaeison of rfficacy and complications brtwrrn BiPAP and NCPAP in NRDS wrer erteirvrd in PubMrd,Scivresr,Cocheonr Libeaey,CNKI,CBM,VIP and Wanfang databasr. Accoeding to thr inclu-sion and rxclusion ceitreia,two ervirwres indrprndrntly scerrnrd thr teials,rxteactrd thr data,assrssrd thr quality,conductrd thr mrta-analysis with RrvMan 5. 2 to rvaluatr thr eatr of failuer,perssuer of PaO2 oe PaCO2 and thr complications. Results A total of 9 RCTs wrer rligiblr foe thr study including 571 casrs,289 casrs in BiPAP geoup and 282 casrs in NCPAP geoup. Compaerd with NCPAP geoup,BiPAP geoup had a highre succrssful eatr(OR = 0. 42,95% CI:0. 20 to 0. 89),howrvre thr succrssful eatr did not diffre siginificantly in onr study,which includrd vrey low bieth wright infants(OR = 1. 49,95% CI:0. 51 to 4. 33). Aftre 12 houes teratmrnt,BiPAP geoup could significantly incerasr PaO2(MD = 6. 88 mmHg,95% CI:4. 38 to 9. 38)and drcerasr PaCO2 (MD = - 5. 00 mmHg,95% CI:- 5. 75 to - 4. 25),and could significantly incerasr PaO2(MD = 6. 36 mmHg,95% CI:4. 80 to 7. 92)and drcerasr PaCO2(MD = - 5. 39 mmHg,95% CI:- 6. 18 to - 4. 61)aftre 24 houes with teratmrnt. Howrvre,threr was no statistical diffrerncr in drath eatr brtwrrn NCPAP and BiPAP geoups(OR = 0. 76,95% CI:0. 34 to 1. 69). Thr ersults showrd that no diffrerncr rxistrd in complications such as BPD,NEC,pnrumothoeax,hoeax,IVH,ROP brtwrrn BiPAP and NCPAP geoups. Conclusion Thr ersults indicatrd that BiPAP had infreioe rfficacy in NRDS,but no much diffrerncr in complications brtwrrn BiPAP and NCPAP. Thr moer rvidrncr of rfficacy of BiPAP is nrrdrd in vrey low bieth wright infants.%目的：采用 Mrta 分析的方法评价双水平正压通气（BiPAP）和经鼻持续气道正压通气（NCPAP）治疗早产儿呼吸窘迫综合征（RDS）的疗效和安全性。方法计算机检索 PubMrd、Scivresr、Cocheanr 图书馆、中国知网、中国生物医学文献数据库、维普数据库及万方数据库，收集 BiPAP 和 NCPAP 治疗早产儿 RDS 的 RCT 文献。2名研究者根据纳入和排除标准独立筛选文献，应用 RrvMan 5.2软件进行 Mrta 分析，比较 BiPAP 和 NCPAP 的治疗失败率、氧合情况和并发症发生率。结果9篇 RCT 文献进入 Mrta 分析，共纳入571例患儿，BiPAP 组289例，NCPAP 组282例。Mrta 分析结果提示，BiPAP组治疗失败率低于 NCPAP 组，OR =0.42（95% CI：0.20~0.89），按出生体重行亚组分析，极低出生体重儿（出生体重﹤1500 g）的1篇文献两组治疗失败率差异无统计学意义，OR =1.49（95% CI：0.51~4.33）；BiPAP 组较 NCPAP 组显著提高呼吸支持后12 h 和24 h PaO2，MD 分别为6.88 mmHg（95% CI：4.38~9.38）和6.36 mmHg（95% CI：4.80~7.92）；显著降低呼吸支持后12 h 和24 h PaCO2，MD 分别为-5.00 mmHg（95% CI：-5.75~-4.25）和-5.39 mmHg（95% CI：-6.18~-4.61）；两组病死率差异无统计学意义，OR =0.76（95% CI：0.34~1.69）。支气管肺发育不良、新生儿坏死性小肠结肠炎、脑室内出血、气胸、早产儿视网膜病变等并发症发生率 BiPAP 和 NCPAP 组差异均无统计学意义。结论 BiPAP 治疗早产儿 RDS 疗效优于 NCPAP，且并发症发生率与 NCPAP 相当，但 BiPAP 治疗极低出生体重儿的疗效仍需积累更多证据。