Ho J J, Henderson-Smart D J, Davis P G
Dept Paediatrics, Perak College of Medicine, Greentown, Ipoh, Malaysia, 30450.
Cochrane Database Syst Rev. 2002;2002(2):CD002975. doi: 10.1002/14651858.CD002975.
The application of a continuous distending pressure (CDP) has been shown to have some benefits in the treatment of pre-term infants with respiratory distress syndrome (RDS). CDP has the potential to reduce lung damage, particularly if applied early before atelectasis has occurred. Early application of CDP may better conserve an infant's own surfactant stores and consequently be more effective than CDP applied later in the course of RDS.
In pre-term infants with RDS to determine if early compared with delayed initiation of CDP results in lower mortality and reduced need for intermittent positive pressure ventilation.
The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register (Issue 1, 2002), MEDLINE (1966-2001), previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, journal hand searching mainly in the English language.
Trials among pre-term infants with respiratory distress syndrome spontaneously breathing at trial entry, which used random or quasi-random allocation to either early or delayed CDP.
Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used, including independent assessment of trial quality and extraction of data by two authors.
In six studies on a total of 165 infants, early CDP was associated with a significant reduction in subsequent use of intermittent positive pressure ventilation, typical RR 0.55, RD -0.16, NNT 6, but there was no evidence of effect on overall mortality. There was no evidence of effect on the rates of pneumothorax (five studies) or bronchopulmonary dysplasia (one study). Early CDP resulted in a reduction in duration of oxygen therapy in the single study reporting this outcome.
REVIEWER'S CONCLUSIONS: Early application of CDP has a clinical benefit in the treatment of RDS in that it reduces subsequent use of IPPV and thus may be useful in preventing the adverse effects of this treatment. However, many of the trials were done in the 1970s and 1980s and re-evaluation of the strategy of early CDP in the era of antenatal steroid use and early surfactant administration is indicated.
持续扩张压力（CDP）的应用已显示出在治疗早产呼吸窘迫综合征（RDS）方面有一些益处。CDP有可能减少肺损伤，尤其是在肺不张发生之前早期应用时。早期应用CDP可能更好地保存婴儿自身的表面活性物质储备，因此比在RDS病程后期应用CDP更有效。
在患有RDS的早产儿中，确定与延迟开始应用CDP相比，早期应用CDP是否能降低死亡率并减少间歇性正压通气的需求。
采用Cochrane新生儿综述组的标准检索策略。这包括检索牛津围产期试验数据库、Cochrane对照试验注册库（2002年第1期）、MEDLINE（1966 - 2001年）、既往综述（包括交叉参考文献、摘要、会议和专题讨论会记录）、专家提供信息者、主要以英文进行的期刊手工检索。
纳入在试验开始时自发呼吸的早产呼吸窘迫综合征婴儿的试验，这些试验采用随机或半随机分配至早期或延迟CDP组。
采用Cochrane协作网及其新生儿综述组的标准方法，包括由两位作者独立评估试验质量和提取数据。
在总共165例婴儿的6项研究中，早期CDP与随后间歇性正压通气的使用显著减少相关，典型相对危险度0.55，差值 -0.16，需要治疗的人数6，但没有证据表明对总体死亡率有影响。没有证据表明对气胸发生率（5项研究）或支气管肺发育不良发生率（1项研究）有影响。在报告该结果的单项研究中，早期CDP导致氧疗时间缩短。
早期应用CDP在治疗RDS方面具有临床益处，因为它减少了随后IPPV的使用，因此可能有助于预防这种治疗的不良反应。然而，许多试验是在20世纪70年代和80年代进行的，在产前使用类固醇和早期给予表面活性物质的时代，有必要重新评估早期CDP策略。
