摘要
目的评价经鼻间歇正压通气（nasal intermittent positive pressure ventilation，NIPPV）治疗早产儿呼吸窘迫综合征（respiratory distress syndrome，RDS）的临床疗效。方法2008年1月至6月，检索PubMed、荷兰医学文摘（Embase）、OVID全文数据库、Coehrane图书馆、中国学术期刊网全文数据库（CNKI）、中国生物医学文献数据库（CBMdisc），收集NIPPV治疗早产儿RDS的临床试验，进行质量分析，并对符合纳入标准的研究应用Revman4．2软件进行Meta分析。结果纳入随机对照研究5篇，共284例RDS早产儿，其中在撤除气管插管呼吸机后阶段应用NIPPV与鼻塞持续正压通气（nasal continuous positive airway pressure，NCPAP）的疗效比较共3篇，Meta分析显示NIPPV组拔管失败率低于NCPAP组（8．34％vs40．79％），差异有统计学意义[RR0．21（95％CI：0．10—0．45；P〈0．001）]；3篇研究中2篇进行了支气管肺发育不良（bronehopulmonary dysplasia，BPD）的分析，Meta分析显示NIPPV组BPD患病率较低（39．34％VS54．39％），但差异无统计学意义[RR0．73（95％CI：0．49～1．07；P=0．11）]；以NIPPV作为初始通气模式2篇，其中与气管插管常规通气（conventional ventilation，cv）模式比较1篇，NIPPV组比CV组BPD患病率低（10％vs33．33％，P＝0．04）；与NCPAP比较1篇，NIPPV组比NCPAP组BPD患病率低（2．33％vs17．07％，P=0．03）。结论NIPPV作为初始通气模式治疗早产儿RDS是可行的，NIPPV组具有较低的BPD患病率。在气管插管呼吸机拔管后阶段应用NIPPV可降低拔管失败率。
Objective To assess the efficacy of nasal intermittent positive pressure ventilation （NIPPV） in treatment of respiratory distress syndrome （RDS） in premature infants. Methods According to the requirements of Cochrane systematic review, a thorough literature search was performed among PubMed （1977-2008）, Embase （1989-2008）, OVID, Cochrane （2008）, Chinese Digital Hospital Library （www. chkd. cnki. net） and Chinese Biomedical Literature Disk Database （CBMdisc）. Quality assessments of clinical trials were carried out. Randomized controlled trials （RCTs） with NIPPV and RDS were enrolled, and Revman 4. 2 software was used for meta-analysis. The trials were analyzed using relative risk （RR） for dichotomous data, weighted mean difference （WMD） were used for continuous data, both kind of data were expressed by 95% confidence intervals （95% CI）. For homogenous data （P≥0. 10）, fixed effects model was calculated, for heterogeneity data （P 〈 0. 10）, random effects model was calculated. Results Five RCTs involving 284 premature infants diagnosed as respiratory distress syndrome （RDS） were included. Three studies comparing NIPPV with nasal continuous positive airway pressure （NCPAP） in the postextubation period, the extubation failure rate was 8. 34% vs 40. 79% in NIPPV group and NCPAP group, the NIPPV group had significantly lower extubation failure rates [ RR 0. 21 （95% CI：0. 10-0.45 ;P 〈 0. 001 ） ]. Two of the above-mentioned three studies analyzed bronchopulmonary dysplasia （BPD） rates, the incidence of BPD was 39. 34% vs 54. 39% in NIPPV group and NCPAP group, the NIPPV group had a trend towards lower BPD rates, but this did not reach statistical significance [ RR 0.73 （95% CI：0. 49-1.07;P= 0. 11 ）]. NIPPV was used as primary mode in two studies, one compared with conventional ventilation （CV）, which detected that the NIPPV group had significantly lower BPD rates （10% vs. 33.33%, P = 0. 04 ）; the other compared with NCPAP, which also
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2009年第7期532-536,共5页
Chinese Journal of Pediatrics
关键词
鼻间歇正压通气
呼吸窘迫综合征
婴儿
早产
Intermittent positive pressure ventilation
Respiratory distress syndrome （RDS）
Infant, premature
