米力农用于新生儿持续性肺动脉高压
Milrinone for persistent pulmonary hypertension of the newborn.
作者信息
Bassler Dirk, Kreutzer Karen, McNamara Patrick, Kirpalani Haresh
机构信息
Department of Neonatology, University Children's Hospital, Tuebingen, Germany.
出版信息
Cochrane Database Syst Rev. 2010 Nov 10;2010(11):CD007802. doi: 10.1002/14651858.CD007802.pub2.
BACKGROUND
Persistent pulmonary hypertension of the newborn (PPHN) is a clinical syndrome characterized by suboptimal oxygenation as a result of sustained elevation in pulmonary vascular resistance after birth. Currently, the therapeutic mainstay for PPHN is optimal lung inflation and selective vasodilatation with inhaled nitric oxide (iNO). However, iNO is not available in all countries and not all infants will respond to iNO. Milrinone is a phosphodiesterase III inhibitor which induces pulmonary vasodilatation by its actions through a cyclic adenylate monophosphate mediated signaling pathway.
OBJECTIVES
To assess efficacy and safety in infants with PPHN either treated with: milrinone compared with placebo or no treatment; milrinone compared with iNO; milrinone as an adjunct to iNO compared with iNO alone; milrinone compared with potential treatments for PPHN other than iNO.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2010), MEDLINE and EMBASE databases from their inception until January 2010. We searched the reference lists of potentially relevant studies without any language restriction.
SELECTION CRITERIA
Fully published randomized controlled trials (RCTs) and quasi-RCTs comparing milrinone with placebo, iNO or potential treatments other than iNO in neonates with PPHN were included if trials reported any clinical outcome.
DATA COLLECTION AND ANALYSIS
We found no studies meeting the criteria for inclusion in this review.
MAIN RESULTS
We found no studies meeting the criteria for inclusion in this review.
AUTHORS' CONCLUSIONS: The efficacy and safety of milrinone in the treatment of PPHN are not known and its use should be restricted within the context of RCTs. Such studies should address a comparison of milrinone with placebo (in clinical situations where iNO is not available) or, in well resourced countries, should compare milrinone with iNO or as an adjunct to iNO compared with iNO alone.
背景
新生儿持续性肺动脉高压（PPHN）是一种临床综合征，其特征为出生后肺血管阻力持续升高导致氧合不佳。目前，PPHN的主要治疗方法是实现最佳肺膨胀以及使用吸入一氧化氮（iNO）进行选择性血管舒张。然而，并非所有国家都有iNO，而且并非所有婴儿都会对iNO产生反应。米力农是一种磷酸二酯酶III抑制剂，它通过环磷酸腺苷介导的信号通路发挥作用，从而引起肺血管舒张。
目的
评估米力农治疗PPHN婴儿的疗效和安全性，比较米力农与安慰剂或不治疗；米力农与iNO；米力农作为iNO的辅助治疗与单独使用iNO；米力农与iNO以外的PPHN潜在治疗方法。
检索策略
我们检索了Cochrane对照试验中心注册库（《Cochrane图书馆》，2010年第2期）、MEDLINE和EMBASE数据库，检索时间从各数据库创建至2010年1月。我们检索了潜在相关研究的参考文献列表，没有任何语言限制。
选择标准
如果试验报告了任何临床结果，则纳入比较米力农与安慰剂、iNO或iNO以外的潜在治疗方法的完全发表的随机对照试验（RCT）和半随机对照试验，这些试验针对患有PPHN的新生儿。
数据收集与分析
我们未找到符合本综述纳入标准的研究。
主要结果
我们未找到符合本综述纳入标准的研究。
作者结论
米力农治疗PPHN的疗效和安全性尚不清楚，其使用应限制在RCT的背景下。此类研究应比较米力农与安慰剂（在没有iNO的临床情况下），或者在资源充足的国家，应比较米力农与iNO，或米力农作为iNO的辅助治疗与单独使用iNO。
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