糖皮质激素治疗胎粪吸入综合征疗效和安全性的Meta分析

摘要

目的 评价糖皮质激素治疗胎粪吸入综合征(MAS)的疗效及安全性.方法 检索PubMed、MEDLINE、EMBASE、EBSCOhost、Cochrane图书馆、Cochrane临床对照试验库(CENTRAL)、Ovid、中国生物医学文献数据库、万方数据库和维普中文科技期刊数据库,检索时间均从建库至2010年12月,并辅以手工检索,获得糖皮质激素治疗MAS的RCT文献.依据随机方法、分配隐藏、盲法、结果数据的完整性、选择性报告研究结果和其他偏倚来源进行文献偏倚评价.采用RevMan 5.0.23软件进行Meta分析,根据异质性结果选择相应的效应模式分析;无法进行Meta分析时采用描述性分析.结果共检索到1 012篇文献,符合纳入标准的5篇RCT文献(n=295)进入Meta分析.文献偏倚评价结果显示,存在低度和高度偏倚风险的文献各1篇,3篇文献存在中度偏倚风险.①Meta分析结果显示,糖皮质激素能显著缩短住院时间(MD=-5.42,95%CI:-7.38～-3.45,P＜0.000 1),减少败血症发生率(OR=0.33,95%CI:0.12～0.78,P=0.01).亚组分析结果显示,布地奈德混悬液雾化吸入可显著缩短住院时间(MD=-6.11,95%CI:-8.88～-3.34,P＜0.000 1)、呼吸窘迫持续时间(SMD=-1.56,95%CI:-2.12～-1.00,P＜0.000.01)和氧疗时间(SMD=-1.22,95%CI:-1.96～-0.48,P=0.001),减少败血症发生率(OR=0.25,95%CI:0.07～0.95,P=0.04).②糖皮质激素组住院期间病死率、胸部X线片恢复正常的时间与对照组差异均无统计学意义.③糖皮质激素组持续性肺动脉高压、鹅口疮及其他浅表部位真菌感染、脑膜炎、高血糖、高血压、慢性肺疾病和生长发育延迟发生率与对照组差异均无统计学意义.结论出生后48 h内雾化吸入布地奈德混悬液可显著缩短MAS患儿住院时间、呼吸窘迫及氧疗时间.糖皮质激素治疗不能改善MAS患儿最终结局,亦不会增加糖皮质激素相关感染的发生.鉴于纳入的RCT文献较少,研究间异质性较大,故结论应谨慎对待.%Objevtive To assess the efficacy and safety of glucocorticoids treatment for meconium aspiration syndrome ( MAS ).Methods Besides manually searching, PubMed, MEDLINE, EMBASE.EBSCOhost, the Cochrane Library, the Cochrane Central Register of Controlled Trials ( CENTRAL ), Ovid, Chinese Biological Medic:al Literature Database ( CBM ),Wanfang Chinese Periodical Datase and VIP Chinese Periodical Database were electronically searched from the establsihment of the database till Decemher 2010.All randomized controlled trials ( RCTs ) about glucocortic:oid treatment initiated within postnatal 48 hours in MAS newborns were eligible.Standard methods of the Cochrane Collaboration were employed to evaluate the methodological quality of the trials.Meta-analysis was performed with RevMan 5.0.23 software, and proper effective model was used according to heterogeneity of the included studies.Descriptive analysis was utilized if meta-analysis was inappropriate.Results A total of 1 012 literatures were reviewed.Five RCTs enrolled with 295 participants were eligible for this meta-analysis, among them 1 trial was in low risk of bias.3 were moderate and 1 was in high risk of bias.Meta-analysis showed that glucocorticoid treatment significantly decreased the hospital stays ( MD = - 5.42.95％CI: - 7.38 to - 3.45.P ＜ 0.0001 ) and the incidenc:e of sepsis ( OR =0.33.95％ CI: 0.12 to 0.78, P = 0.01 ).Meta-analysis in subgroups indicated that budesonide inhalation decreased significantly the hospital stays( MD = - 6.11, 95％ CI: - 8.88 to - 3.34, P ＜ 0.000 1 ).the duration of respiratory distress ( SMD = - 1.56.95％ CI: - 2.12 to - 1.00,P＜0.000 01 ), the duration of oxygen therapy ( SMD = - 1.22.95％ CI: - 1.96 to -0.48.P = 0.001 ) and the incidence of sepsis ( OR = 0.25.95％ CI: 0.07 to 0.95.P = 0.04 ).None of glucocorticoid therapies significantly influenced the mortality during hospitalization.duration of chest X-ray clearance, or incidence of oral thrush,superficial fungal infection or meningitis.Descriptive analysis indicated that the glucocorticoids had no effect on the incidence of persistent pulmonary hypertension newborn, air leak, hyperglycemia, hypertension, chronic lung disease ( CLD ), delayed growth or development.Conclusions Budesonide suspension inhalation initiating within 48 hours postnatal in MAS newboms can significantly shorten hospital stays, duration of respiratory distress and oxygen therapy.Glucocorticoid treatment neither improves the final outcome of MAS newborns, nor increases the incidence of secondary infection.