论文部分内容阅读
目的评价治疗新生儿持续性肺动脉高压(PPHN)措施的有效性和安全性,为临床应用提供指导。方法通过数据库检索出符合纳入分析条件的相关文献9篇,采用Meta分析方法进行定性、定量综合分析,得出合并优势比(OR)及其95%可信区间。结果目前尚无随机病例对照试验(randomized controlled trial,RCT)对过度通气、高频通气、控制性碱血症、扩血管药物(硫酸镁、妥拉苏林、前列腺素与前列环素、米力农)肺表面活性物质、治疗PPHN的临床效果进行评价;口服西地那非可降低PPHN患儿的氧合指数(OI)(P<0.01),降低住院期间患儿的病死率(P<0.05);iNO治疗PPHN后30～60min可显著升高患儿的动脉血氧分压(P<0.00001)、减少使用体外膜肺(ECMO)(P<0.00001),长期神经系统的发育随访和对照组比较差异无统计学意义(P>0.05);成本-效果分析吸入一氧化氮(iNO)治疗PPHN,每个患儿多花费1141美元,增量成本-效果比为33234美元;ECMO治疗PPHN可减少住院期间新生儿病死率(P<0.05),患儿1岁时神经系统发育和对照组比较差异无统计学意义(P>0.05)。结论iNO可显著升高患儿的动脉血氧分压,ECMO治疗可减少患儿的病死率,但增加治疗成本;口服西地那非治疗PPHN疗效评价的随机对照实验(RCT)样本量较少,需要进一步加大样本量。对传统治疗PPHN的措施应进行设计严格、多中心、大样本的RCT。
Objective To evaluate the effectiveness and safety of PPHN in the treatment of neonatal pulmonary hypertension (PPHN) and provide guidance for its clinical application. Methods A total of 9 articles were retrieved from the database, and the results were analyzed qualitatively and quantitatively using Meta analysis. The OR and 95% confidence intervals were obtained. Results There were no randomized controlled trials (RCTs) for hyperventilation, high-frequency ventilation, controlled alkalosis, vasodilators (magnesium sulfate, tolazulin, prostaglandin and prostacyclin, (P <0.01). The oral administration of sildenafil reduced the oxygenation index (OI) in children with PPHN (P <0.05), and decreased the mortality of children with hospital stay (P <0.05) ); iNO treatment of PPHN 30 ~ 60min can significantly increase the arterial partial pressure of oxygen (P <0.00001), reduce the use of extracorporeal membrane lung (ECMO) (P <0.00001), long-term development of the nervous system follow-up and control group (P> 0.05); cost-effectiveness analysis of nitrous oxide (iNO) treatment of PPHN, each child spent an extra $ 1141, cost-effectiveness ratio of $ 33,234; ECMO PPHN treatment can be reduced Neonatal mortality during hospitalization (P <0.05), 1 year old children with nervous system development and control group, the difference was not statistically significant (P> 0.05). Conclusions iNO can significantly increase the partial pressure of arterial oxygen in children. ECMO treatment can reduce the mortality of children, but increase the cost of treatment. The randomized controlled trial (RCT) sample with less effect of oral sildenafil on PPHN is less , Need to further increase the sample size. The traditional treatment of PPHN measures should be designed strictly, multi-center, large samples of RCT.