本文選題：先天性心臟病　切入點：肺動脈高壓　出處：《廣西醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的評價吸入一氧化氮治療兒童先天性心臟病(CHD)術(shù)后合并肺動脈高壓(PAH)的近期療效和安全性。 方法檢索美國生物醫(yī)學(xué)數(shù)據(jù)庫（MEDLINE OvidSP）、荷蘭醫(yī)學(xué)文摘（EMBASE OvidSP）、Cochrane臨床對照試驗庫（CENTRAL）、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫(CBM)、中國知識資源總庫（CNKI）和在研對照試驗數(shù)據(jù)庫，檢索時間從數(shù)據(jù)庫建庫到2012年4月，獲得吸入一氧化氮治療兒童CHD術(shù)后合并PAH的RCT文獻。采用《Cochrane系統(tǒng)評價員手冊5.1.2》推薦的隨機方法、分配隱藏、盲法、隨訪偏倚、結(jié)果數(shù)據(jù)的完整性和其他偏倚來源評價納入的文獻的方法學(xué)質(zhì)量。用RevMan5.1軟件進行Meta分析，根據(jù)異質(zhì)性結(jié)果選擇相應(yīng)的效應(yīng)模式分析，對無法合并行Meta分析的結(jié)果進行描述性分析。 結(jié)果共檢索到相關(guān)文獻984篇，其中6篇符合標(biāo)準(zhǔn)的RCT文獻進入Meta分析，涉及研究對象220例。納入文獻方法學(xué)質(zhì)量評價結(jié)果顯示，2篇文獻存在低度偏倚風(fēng)險，1篇文獻存在中度偏倚風(fēng)險，3篇文獻存在高度偏倚風(fēng)險。①研究結(jié)果顯示，吸入一氧化氮可降低收縮期肺動脈壓（SMD=-0.83(95%CI=-1.40--0.26,p=0.004)，顯著縮短拔管時間、機械通氣時間和重癥監(jiān)護時間。②吸入一氧化氮組出院前病死率、肺動脈高壓危象發(fā)生率、平均肺動脈壓、平均動脈壓、心率、心排血指數(shù)、氧合指數(shù)與對照組差異均無統(tǒng)計學(xué)意義。③吸入一氧化氮可顯著提高高鐵血紅蛋白濃度（MD=0.40，95%CI=0.20-0.60,p0.0001)和二氧化氮濃度，但仍在正常范圍內(nèi)。 結(jié)論現(xiàn)有數(shù)據(jù)顯示，吸入NO未能顯著的降低出院前病死率、肺動脈高壓危象發(fā)生率和平均肺動脈壓，亦未能顯著提高心排血指數(shù)和氧合指數(shù)。但吸入NO可能有效降低收縮期肺動脈壓、拔管時間、機械通氣時間和重癥監(jiān)護時間。鑒于此次研究納入的RCT文獻研究對象少，文獻總體質(zhì)量不高，研究間存在異質(zhì)性，故應(yīng)謹(jǐn)慎對待本研究結(jié)論，對于一氧化氮的確切療效應(yīng)開展前瞻性、大樣本、多中心的隨機對照試驗進一步論證。
[Abstract]:Objective to evaluate the short-term efficacy and safety of inhaled nitric oxide (no) in the treatment of children with congenital heart disease (CHD) with pulmonary hypertension (PAH).
The United States biomedical database retrieval method (MEDLINE OvidSP), Holland Medical Abstracts (EMBASE OvidSP), Cochrane clinical controlled trials database (CENTRAL), Chinese biomedical literature database (CBM), China knowledge resources database (CNKI) and in the research of controlled trials database, retrieved from the database by April 2012, PAH RCT combined with literature get inhaled nitric oxide therapy in children with CHD after operation. The stochastic method using the recommended allocation concealment and blinding, follow-up bias, quality methods into the integrity of the data and other sources of bias evaluation results. Meta analysis was carried out using RevMan5.1 software according to the heterogeneity of the corresponding mode selection effect the analysis, descriptive analysis of Meta cannot merge the results of the analysis.
Results a total of 984 literatures, 6 of them in accordance with the standard RCT documents into Meta analysis, involving 220 subjects included in the literature. The methodological quality evaluation results show that 2 articles have a low risk of bias, 1 articles with moderate bias risk and 3 RCTs with high risk of bias. The results showed that that inhaled nitric oxide can reduce systolic pulmonary artery pressure (SMD=-0.83 (95%CI=-1.40--0.26, p=0.004), significantly shorten the extubation time, duration of mechanical ventilation and intensive care time. The inhaled nitric oxide before the discharge mortality rate, the incidence of pulmonary hypertension, mean pulmonary arterial pressure, mean arterial pressure, heart rate, cardiac index, oxygen composite index showed no significant difference from the control group. The inhaled nitric oxide can significantly increase the concentration of methemoglobin (MD=0.40,95%CI=0.20-0.60, P0.0001) and two nitric oxide concentrations, but still in it In a constant range.
Conclusion the existing data show that inhaled NO failed to significantly reduce mortality before discharge, pulmonary hypertension incidence and mean pulmonary artery pressure, also failed to significantly improve cardiac index and oxygen index. But inhaled NO may be effective in decreasing systolic pulmonary artery pressure, extubation time, mechanical ventilation time and duration of intensive care in view of the research into RCT. Literature research object, the overall quality of literature is not high, there is heterogeneity among the studies, the conclusions of this study should be treated with caution, for the exact therapeutic effects of nitric oxide in a prospective, large sample, multi center randomized controlled trials further demonstrated.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R726.5

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