Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Department of Pediatrics, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.
J Perinatol. 2010 Jun;30(6):373-8. doi: 10.1038/jp.2009.126. Epub 2009 Aug 20.
A full consensus has not been reached about the hemodynamic efficacy of hydrocortisone administration in hypotensive and vasopressor-dependent preterm neonates.
To examine the efficacy of hydrocortisone for treatment of hypotension and reduction of vasopressor requirements in preterm infants.
Standard meta-analytic techniques, including random and fixed effects models, were used to calculate combined effect size correlations and significance levels.
Random effects meta-analysis showed that hydrocortisone increases blood pressure (seven studies; N=144; r=0.71, 95%CI=0.18 to 0.92) and reduces vasopressor requirement (five studies; N=93; r=0.74, 95%CI=0.0084 to 0.96). The number of new or unretrieved studies averaging null results required to increase the overall p to 0.05 is k=78 for blood pressure increase and k=47 for vasopressor requirement reduction.
The effects of hydrocortisone on increasing blood pressure and decreasing vasopressor requirements in preterm infants are robust with a large tolerance for future null results. Actual clinical benefits of increasing blood pressure and decreasing vasopressor requirements, however, remain unknown. Long-term sequelae of hydrocortisone administration have yet to be fully elucidated.
对于低血压和需要血管加压药物治疗的早产儿，氢化可的松治疗的血流动力学效果尚未达成完全共识。
研究氢化可的松治疗早产儿低血压和减少血管加压药物需求的疗效。
采用标准荟萃分析技术，包括随机和固定效应模型，计算合并效应大小相关性和显著性水平。
随机效应荟萃分析显示，氢化可的松可升高血压（7 项研究；N=144；r=0.71，95%CI=0.18 至 0.92）和减少血管加压药物需求（5 项研究；N=93；r=0.74，95%CI=0.0084 至 0.96）。为使总体 p 值增加到 0.05 而需要增加平均为零结果的新研究或未检索研究数量为：血压升高时 k=78，血管加压药物需求减少时 k=47。
氢化可的松对早产儿升高血压和减少血管加压药物需求的作用具有很强的稳健性，对未来的阴性结果具有较大的容忍度。然而，增加血压和减少血管加压药物需求的实际临床益处仍不清楚。氢化可的松给药的长期后果尚未完全阐明。
