摘要
目的评价合成与天然的表面活性物质治疗新生儿呼吸窘迫综合征的疗效和安全性。方法检索Cochrane图书馆、PubMed、EMBASE、中国生物医学文献光盘数据库、中国期刊全文数据库和中国维普数据库等,检索时间均从建库至2007年12月31日,由3名系统评价员进行资料提取和质量评价,对同质资料进行meta分析。结果共纳入13项研究(n=4841)。根据随机方法、分配隐藏、盲法和随访情况描述评分,11项为A级,1项为B级,1项为C级。meta分析结果显示:①蛋白类合成与天然的外源性表面活性物质对比治疗新生儿呼吸窘迫综合征,其病死率(OR=0.76,95%CI:0.56-1.04),慢性肺疾病(OR=1.06,95%CI:0.81-1.40),慢性肺疾病和死亡(OR=1.00,95%CI:0.77-1.31),脓毒症(OR=1.01,95%CI:0.75-1.36),动脉导管未闭(OR=0.97,95%CI:0.59-1.62),气胸(OR=1.00,95%CI:0.69-1.45),差异均无统计学意义。②非蛋白类合成与天然的外源性表面活性物质对比治疗新生儿呼吸窘迫综合征,病死率(OR=1.13,95%CI:0.97-1.32;χ2=14.38,P=0.11);慢性肺疾病(OR=1.08,95%CI:0.92-1.26;χ2=3.45,P=0.49);脓毒症(OR=1.05,95%CI:0.90-1.21;χ2=13.10,P=0.07);动脉导管未闭(OR=1.02,95%CI:0.86-1.21;χ2=6.74,P=0.24);慢性肺疾病和死亡(随机效应模型)(OR=1.04,95%CI:0.79-1.37;χ2=6.53,P=0.09)等差异均无统计学意义。气胸(OR=1.55,95%CI:1.28-1.87;χ2=10.01,P=0.26)差异有统计学意义。结论蛋白类合成表面活性物质无论在安全性还是疗效方面均不差于天然表面活性物质;非蛋白类合成表面活性物质的疗效与天然性表面活性物质差异无统计学意义,但安全性方面差于天然性表面活性物质。
Objectives To assess the effectiveness and safety of synthetic surfactant versus natural surfaetant extracts for treatment of neonatal respiratory distress syndrome. Methods The data from Coehrane library, PubMed, EMBASE, CBMdisc, CNKI, VIP have been searched from the establishment of the database till 31 December 2007. Data extraction, quality assessment, and meta-analysis for the results of homogeneous studies were done by three reviewers. Results Thirteen studies with 4 841 participants were included. All the studies were graded in terms of randomization, allocation concealment and blinding. Eleven studies were graded as A, one as B, and one as C. The result of recta-analysis showed： 1 ） Protein-containing synthetic suffaetant vs animal-derived suffactant： there was no statistical significance on mortality （OR = 0.76, 95% CI： 0.56- 1.04）, chronic lung disease （OR = 1.06, 95% CI： 0.81- 1.40）, chronic lung disease or death （OR = 1.00, 95% CI： 0.77- 1.31）, sepsis （OR = 1.01, 95% CI： 0.75- 1.36）, patent duetus arteriosus（OR = 0.97, 95% CI： 0.59 - 1.62）, pneumothorax （OR = 1.00, 95% CI： 0.69 - 1.45）. 2） Non-proteincontaining synthetic suffaetant vs animal-derived suffactant： there was no statistical significance on mortality （OR = 1.13, 95% CI： 0.97- 1.32）, chronic lung disease （OR = 1.08, 95% CI： 0.92- 1.26）, sepsis （OR = 1.05, 95% CI： 0.90- 1.21）, patent ductus arteriosus （OR = 1.02, 95% CI： 0.86 - 1.21） chronic lung disease or death （random）（OR = 1.04, 95% CI： 0.79- 1.3）. However, the difference on occurrence of pneumothorax （OR = 1.55, 95% CI： 1.28- 1.87） was significant （χ^2 = 10.01, P = 0.26）. Conclusions Available evidence showed that compared with animal-derived suffactant, protein-containing synthetic suffactant was at least comparable with, if not superior to, that of animal-derived surfactants. The non-protein-containing synthetic surfactant was similar to animal-derived surfactant oneffectiveness, but not on safet
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2008年第12期1074-1081,共8页
Journal of Clinical Pediatrics
