【摘要】：目的系統(tǒng)評價吸入性糖皮質(zhì)激素預防早產(chǎn)兒慢性肺疾病(CLD)的有效性和安全性。方法計算機檢索Pub Med、EMBASE、CENTRAL、the ISI Web of Knowledge Databases、CBM、CNKI和VIP、Wan Fang Data,檢索時限均為建庫至2016年10月,搜集所有研究吸入性糖皮質(zhì)激素防治早產(chǎn)兒CLD的療效和安全性的隨機對照試驗(RCT),并進行RCT的篩選、資料提取和質(zhì)量評價,應用Rev Man 5.3軟件進行meta分析。結果共納入12篇RCT,2 051例早產(chǎn)兒。與對照組比較,28天組吸入糖皮質(zhì)激素組,以及吸入布地奈德亞組、倍氯米松亞組和氟替卡松亞組,CLD發(fā)生率的差異無統(tǒng)計學意義(P均0.05)。與對照組比較,校正胎齡36周組吸入糖皮質(zhì)激素組(RR=0.70,95%CI:0.61~0.80)、霧化吸入亞組(RR=0.74,95%CI:0.63~0.87)、氣管內(nèi)給藥亞組(RR=0.57,95%CI:0.43~0.76)以及布地奈德亞組(RR=0.67;95%CI:0.57~0.78)和氟替卡松亞組(RR=0.58,95%CI:0.36~0.94),CLD發(fā)生率的差異有統(tǒng)計學意義(P均0.05);而倍氯米松組CLD發(fā)生率與對照組差異無統(tǒng)計學意義(P=0.90);總的病死率差異無統(tǒng)計學意義(P=0.55);霧化吸入亞組和氣管內(nèi)給藥亞組以及布地奈德亞組、倍氯米松亞組和氟替卡松亞組病死率與對照組比較差異無統(tǒng)計學意義(P均0.05)。結論預防性使用吸入性糖皮質(zhì)激素能有效降低早產(chǎn)兒CLD的發(fā)病率,但對病死率無影響,與給藥方式和給藥類型無顯著相關性。同時推薦以校正胎齡36周為結局指標觀察點,但相關研究數(shù)量有限,且缺乏長期隨訪結果,因此吸入性糖皮質(zhì)激素的作用及遠期并發(fā)癥,仍需大量的臨床研究來評估,建議臨床謹慎使用。
[Abstract]:Objective to evaluate the efficacy and safety of inhaled glucocorticoid in the prevention of (CLD) in premature infants with chronic lung disease. Methods both Pub Med,EMBASE,CENTRAL,the ISI Web of Knowledge Databases,CBM,CNKI and VIP,Wan Fang Data, were searched by computer until October 2016. All randomized controlled trials (RCT),) to study the efficacy and safety of inhaled glucocorticoid in preventing and treating CLD in premature infants were collected and RCT screening was performed. Data extraction and quality evaluation, meta analysis using Rev Man 5.3 software. Results A total of 12 RCT,2 cases were included in this study. Compared with the control group, there was no significant difference in the incidence of CLD in the 28 day inhaled glucocorticoid group, the inhaled budesonide subgroup, beclomethasone subgroup and fluticasone subgroup (P0. 05). Compared with the control group, The incidence of corticosteroid inhalation (RR=0.70,95%CI:0.61~0.80), nebulized inhaled subgroup (RR=0.74,95%CI:0.63~0.87), intratracheal administration subgroup (RR=0.57,95%CI:0.43~0.76), budesonide subgroup (RR=0.67;95%CI:0.57~0.78) and fluticasone subgroup (RR=0.58,95%CI:0.36~0.94), CLD) in 36 weeks of corrected gestational age group were significantly different, whereas the incidence of CLD in beclomethasone group was significantly higher than that in beclomethasone group (P < 0. 05). There was no significant difference between the incidence rate and the control group (P < 0.90), there was no significant difference in the overall mortality rate (P < 0.55), the nebulization subgroup, the intratracheal administration subgroup and the budesonide subgroup were not significantly different from those in the control group. There was no significant difference in mortality between betamethasone subgroup and fluticasone subgroup (P 0.05). Conclusion prophylactic use of inhaled glucocorticoids can effectively reduce the incidence of CLD in premature infants, but has no effect on the mortality, and has no significant correlation with the administration mode and type of administration. At the same time, 36 weeks of corrected gestational age is recommended as the observation point of outcome, but the number of related studies is limited and there is no long-term follow-up results. Therefore, the role of inhaled glucocorticoids and long-term complications still need a large number of clinical studies to evaluate. Clinical caution is recommended.
【作者單位】： 西南醫(yī)科大學附屬醫(yī)院新生兒科;
【分類號】：R722.6

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