【摘要】 目的:系统评价不同剂量牛肺表面活性剂(calf pulmonary surfactant,CPS)治疗新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的安全性和有效性。方法:检索中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、万方数据库(Wanfang Data)、Google学术、PubMed、Cochrane Library、Embase建库至2017年8月的相关文献,筛选不同剂量CPS治疗NRDS的随机对照研究。采用RevMan 5.2软件进行统计学处理。结果:共纳入6篇文献(533例患者)。Meta分析结果显示:应用CPS 100 mg/kg治疗NRDS相对70 mg/kg,可有效降低患儿动脉二氧化碳分压[OR=-3.21,95%CI(-5.01,-1.41),P=0.000 5],升高动脉氧分压[OR=5.79,95%CI(4.05,7.52),P<0.000 01]和pH值[OR=0.03,95%CI(0.00,0.05),P=0.02],缩短辅助通气时间[OR=-0.64, 95%CI(-1.30,0.10),P=0.02]、住院时间[OR=-2.31,95%CI(-3.94,-0.67),P=0.006]和氧疗时间[OR=-1.40,95%CI(-2.13,-0.66),P=0.02],减少用药次数[OR=-0.27,95%CI(-0.38,-0.16),P<0.000 01]。CPS 70 mg/kg相对40 mg/kg,可降低患儿动脉二氧化碳分压[OR=-2.62, 95%CI(-4.88,-0.35),P=0.02]和氧合指数[OR=-1.82, 95%CI(-2.67,0.97),P<0.000 1],促进胸片好转[OR=-0.20,95%CI(-0.39,-0.01),P=0.04],缩短辅助通气时间[OR=-0.96,95%CI(-1.48,-0.45),P=0.000 2]、氧疗时间[OR=-3.50,95%CI(-4.20,-2.80),P<0.000 01]、住院时间[OR=-2.35,95%CI(-3.55,-1.14),P=0.000 1],减少用药次数[OR=-0.23,95%CI(-0.39,-0.07),P=0.000 5]。应用CPS 40、70、100 mg/kg治疗NRDS,患儿的治愈率、治疗费用和并发症发生情况均无显著性差异。结论:当前证据表明,与40、70 mg/kg CPS相比,应用100 mg/kg CPS治疗NRDS的疗效更显著。更多还原

【Abstract】 Objective: To systematically evaluate the safety and efficacy of different doses of calf pulmonary surfactant（CPS） in the treatment of neonatal respiratory distress syndrome（NRDS）.Methods: All the related literature was retrieved from the databases of Chinese National Knowledge Infrastructure（CNKI）,China Science and Technology Journal Database（VIP）,Wanfang Data,Google Scholar,Pubmed,Cochrane Library,Embase from the inception to August 2017.The randomized controlled trails（RCTs） about the application of different doses of CPS in the treatment of NRDS were collected for the study.Meta analysis was performed using RevMan 5.2 software.Results: A total of 6 RCTs were included,encompassing 533 patients.Meta analysis showed that compared with 70 mg/kg CPS,the application of 100 mg/kg CPS could more effectively decrease the arterial partial pressure of carbon dioxide（PaCO₂） [OR=-3.21,95%CI（-5.01,-1.41）,P=0.000 5],increase arterial partial pressure of oxygen[OR=5.79,95%CI（4.05, 7.52）,P<0.000 01] and pH value[OR=0.03,95%CI（0.00,0.05）,P=0.02],reduce the time of assisted ventilation[OR=-0.64, 95%CI（-1.30,0.10）,P=0.02],hospitalization time[OR=-2.31,95%CI（-3.94,-0.67）,P=0.006],oxygen therapy time[OR=-1.40,95%CI（-2.13,-0.66）,P=0.02] and medication time as well [OR=-0.27,95%CI（-0.38,-0.16）,P<0.000 01].Compared with 40 mg/kg CPS,the application of 70 mg/kg CPS in the treatment of NRDS could also more effectively decrease PaCO₂[OR=-2.62, 95%CI（-4.88,-0.35）,P=0.02] and oxygenation index[OR=-1.82, 95%CI（-2.67,0.97）,P<0.000 1],promote chest radiography improvement[OR=-0.20,95%CI（-0.39,-0.01）,P=0.04],shorten the time of assisted ventilation[OR=-0.96,95%CI（-1.48,-0.45）,P=0.000 2],oxygen therapy time[OR=-3.50,95%CI（-4.20,-2.80）,P<0.000 01] and hospitalization time[OR=-2.35,95%CI（-3.55,-1.14）,P=0.000 1] and decrease medication times[OR=-0.23,95%CI（-0.39,-0.07）,P=0.000 5].There were no significant differences in cure rates,treatment costs and complication rates after treatment with 40,70,100 mg/kg CPS.Conclusion: Current evidence indicated that compared with 40 and 70 mg/kg CPS,the application of 100 mg/kg CPS in the treatment of NRDS was obviously more efficient.更多还原