Lau Christine S M, Chamberlain Ronald S, Sun Shyan
Saint Barnabas Medical Center, Livingston, NJ, USA.
Saint George's University, Grenada, West Indies.
Glob Pediatr Health. 2017 Mar 24;4:2333794X17696683. doi: 10.1177/2333794X17696683. eCollection 2017.
Neonatal respiratory distress syndrome due to surfactant deficiency is associated with high morbidity and mortality in preterm infants, and the use of less invasive surfactant administration (LISA) has been increasingly studied. This meta-analysis found that LISA via thin catheter significantly reduced the need for mechanical ventilation within the first 72 hours (relative risk [RR] = 0.677; = .021), duration of mechanical ventilation (difference in means [MD] = -39.302 hours; < .001), duration of supplemental oxygen (MD = -68.874 hours; < .001), and duration of nasal continuous positive airway pressure (nCPAP; MD = -28.423 hours; = .010). A trend toward a reduction in the incidence of bronchopulmonary dysplasia was observed (RR = 0.656; = .141). No significant difference in overall mortality, incidence of pneumothorax, or successful first attempts was observed. LISA via thin catheter significantly reduces the need for mechanical ventilation within the first 72 hours as well as the duration of mechanical ventilation, supplemental oxygen, and nCPAP. LISA via thin catheter appears promising in improving preterm infant outcomes.
由于表面活性剂缺乏导致的新生儿呼吸窘迫综合征与早产儿的高发病率和死亡率相关，且对使用侵入性较小的表面活性剂给药方法（LISA）的研究越来越多。这项荟萃分析发现，通过细导管进行LISA可显著降低72小时内机械通气的需求（相对危险度[RR]=0.677；P=0.021）、机械通气持续时间（平均差[MD]=-39.302小时；P<0.001）、补充氧气持续时间（MD=-68.874小时；P<0.001）以及经鼻持续气道正压通气（nCPAP）持续时间（MD=-28.423小时；P=0.010）。观察到支气管肺发育不良的发生率有降低趋势（RR=0.656；P=0.141）。在总体死亡率、气胸发生率或首次尝试成功率方面未观察到显著差异。通过细导管进行LISA可显著降低72小时内机械通气的需求以及机械通气、补充氧气和nCPAP的持续时间。通过细导管进行LISA在改善早产儿预后方面似乎很有前景。
