不同通气策略对新生儿呼吸窘迫综合征治疗的安全性评价：网状Meta分析

吴竞; 温子豪; 刘丹丹; 吴晨飞; 张勇; 张兰; 徐友兰; 杨光; 荆春霞

Abstract

吴竞,温子豪,刘丹丹,吴晨飞,张勇,张兰,徐友兰,杨光,荆春霞.不同通气策略对新生儿呼吸窘迫综合征治疗的安全性评价：网状Meta分析[J].Chinese journal of Epidemiology,2020,41(2):249-260

不同通气策略对新生儿呼吸窘迫综合征治疗的安全性评价：网状Meta分析

Safety evaluation on different ventilation strategies set for neonatal respiratory distress syndrome: a network Meta-analysis

Received:May 05, 2019

DOI：10.3760/cma.j.issn.0254-6450.2020.02.020

KeyWord: 通气策略早产儿新生儿呼吸窘迫综合征安全性评价网状Meta分析

English Key Word: Ventilation strategy Premature infants Neonatal respiratory distress syndrome Safety evaluation Mesh Meta-analysis

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Author Name	Affiliation	E-mail
Wu Jing	Department of Epidemiology and Health Statistics, School of Basic Medical Sciences, Jinan University, Guangzhou 510632, China Department of Pathogenic Biology, Jinan University, Guangzhou 510632, China
Wen Zihao	Department of Epidemiology and Health Statistics, School of Basic Medical Sciences, Jinan University, Guangzhou 510632, China
Liu Dandan	Department of Epidemiology and Health Statistics, School of Basic Medical Sciences, Jinan University, Guangzhou 510632, China
Wu Chenfei	School of Medicine, Zhongshan University, Guangzhou 510080, China
Zhang Yong	Department of Neonatology, Dongguan Maternal and Child Health Hospital, Dongguan 523000, China
Zhang Lan	Department of Neonatology, Dongguan Maternal and Child Health Hospital, Dongguan 523000, China
Xu Youlan	Department of Neonatology, Dongguan Maternal and Child Health Hospital, Dongguan 523000, China
Yang Guang	Department of Pathogenic Biology, Jinan University, Guangzhou 510632, China
Jing Chunxia	Department of Epidemiology and Health Statistics, School of Basic Medical Sciences, Jinan University, Guangzhou 510632, China	jcxphd@gmail.com

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Abstract:

目的利用网状Meta分析评估不同通气方法对新生儿呼吸窘迫综合征（NRDS）死亡率和并发症发生率的相对安全性。方法检索1986年1月至2018年6月在PubMed、Cochrane、Web of Science、EBSCO和Springer Link数据库收录的关于平均孕周 < 32周且符合NRDS诊断标准的早产儿肺通气策略的临床随机对照试验。采用Revman 5.3基于Cochrane文献质量评价工具进行纳入研究的质量评价，采用WinBUGS1.4.3、STATA 13.0软件对纳入的文献数据进行基于贝叶斯和频率学方法对提取的数据进行网状Meta分析，评价不同通气策略对早产的NRDS患儿死亡率和相关并发症，如脑室出血（IVH）、动脉导管未闭（PDA）和视网膜病变（ROP）的安全性。计数资料选取OR及95%CI表示。结果本研究共纳入了31项随机对照试验，其中包括了5 827名早产儿和11种通气策略。针对早产儿死亡率、PDA和ROP，11种通气策略相比，差异无统计学意义。共有28项研究报告了IVH结果，与经鼻间歇性正压通气（NIPPV）相比，高频震荡通气（HFOV）（OR=3.33，95%CI：1.08~16.67，P < 0.05）和同步间歇性机械通气（SIMV）（OR=8.22，95%CI：1.25~29.44，P < 0.05）可能会增加NRDS患儿发生IVH的风险。在累积概率排序中，NIPPV是最佳通气策略；聚类排序结果显示，在综合考虑了IVH、PDA和ROP与死亡率的排序之后，NIPPV可能是治疗NRDS患儿的最佳通气策略，而HFOV、IMV和SIMV可能是安全性差的通气策略。结论临床决策者在采用机械通气治疗NRDS患儿时，建议首选NIPPV，以降低IVH发生率，改善死亡、PDA和ROP的发生，不建议对孕周 < 32周的NRDS患儿应用HFOV、SIMV和IMV，上述结论亟待更大样本量的多中心RCT研究予以明确证实。

English Abstract:

Objective To evaluate the relative safety of different ventilation methods regarding mortality and rates of complication, on neonatal respiratory distress syndrome (NRDS). Methods Network Meta-analysis was used to collect data on randomized controlled trials of pulmonary ventilation strategies in preterm infants with a mean gestational age of less than 32 weeks. Diagnostic criteria on NRDS were published in the PubMed, Cochrane, Web of Science, EBSCO, and Springer Link databases from January 1986 to June 2018. Revman 5.3 software was used to evaluate the quality of studies, based on the Cochrane quality assessment tool. Data were analyzed by Bayesian and frequency methods, using both Win BUGS 1.4.3 and STATA 13.0 software. Safety of different ventilation strategies for NRDS mortality and complications would include intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA) and retinopathy of prematurity (ROP) and were evaluated. Counted data was displayed by OR and 95%CI. Results A total of 31 RCTs were included in this paper, including 5 827 preterm infants and 11 ventilation strategies. There were no statistically significant differences appearing in 11 ventilation strategies on mortality, PDA or ROP. IVH results were reported in 28 studies. Compared with nasal intermittent positive pressure ventilation (NIPPV), both high-frequency oscillation ventilation (HFOV) (OR=3.33, 95%CI:1.08-16.67, P < 0.05) and synchronized intermittent mechanical ventilation (SIMV) (OR=8.22, 95%CI:1.25-29.44, P < 0.05) schemes seemed to have increased the risk of IVH in preterm infants with NRDS. NIPPV appeared the optimal ventilation strategy in the rankings of cumulative probability. Results on clustering showed that NIPPV was probably the best ventilation strategy for children with NRDS after considering the orders of IVH, PDA and ROP on mortality, respectively. However, HFOV, IMV, and SIMV did not seem to be the ideal ventilated strategies. Conclusions Most of the clinical decision makers might prefer using NIPPV in the treatment of children with NRDS through mechanical ventilation systems to reduce both the incidence and death caused by IVH, PDA and ROP. It was not recommended to use HFOV, SIMV and IMV in treating NRDS with gestational less than 32 weeks. We suggested that larger numbers of multi-center RCTs ba carried out to make the above conclusions more convincing.

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