吸入一氧化氮对足月或近足月出生的呼吸衰竭婴儿体外膜肺氧合（ECMO）使用率及死亡率的影响。

Effect of NO inhalation on ECMO use rate and mortality in infants born at or near term with respiratory failure.

作者信息

Wang Xiaoqing, Li Bowen, Ma Yuqing, Zhang Hong

机构信息

Department of Anesthesiology, Lanzhou University First Affiliated Hospital, Lanzhou, China.

出版信息

Medicine (Baltimore). 2019 Oct;98(41):e17139. doi: 10.1097/MD.0000000000017139.

DOI:10.1097/MD.0000000000017139

PMID:31593077

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6799754/

Abstract

BACKGROUND

The molecular studies showed that Nitric oxide (NO) is an essential factor which regulates pulmonary artery tension. However, the conclusions of existing clinical studies were inconsistent.

OBJECTIVE

This meta-analysis is aimed to determine whether the inhalation of NO could improve oxygenation and reduce rate of death and use of extracorporeal membrane oxygenation (ECMO).

METHODS

The strategies used to search PubMed, The Cochrane Central Register of Controlled trials in the Cochrane Library, Embase, Web of science, Clinical Trials Registry, and China Biology Medicine disc, from inception to February, 2018. The primary outcomes were death or use of ECMO, death before hospital discharge, use of ECMO before hospital discharge, change in PaO2 after treatment. We assess the risk of bias in each included study by Cochrane Handbook, and calculated typical estimates of RR, each with its 95% CI, and for continuous outcomes, WMD or a summary estimate for SMD, each with its 95% CI.

RESULTS

Nine randomized controlled trials (RCTs) with a total of 856 participants were included in this meta-analysis. This meta-analysis revealed that the experimental group had significantly lower death or use of ECMO (RR 0.66, 95% CI 0.57-0.77, I = 0%, P < .00001) and lower use of ECMO before hospital discharge (RR 0.89, 95% CI 0.50-0.71, I = 0%, P < .00001) compared to control group. And in the infants without diaphragmatic hernia, experimental group had significantly higher change in PaO2 after treatment (MD 50.40, 95% CI 32.14-68.66, P < .00001). The meta-analysis also showing a tendency to improve in the death before hospital discharge (RR 0.89, 95% CI 0.60-1.31, I = 0%, P = .55) and the change in PaO2 after treatment of the infants with diaphragmatic hernia (MD 6.70, 95% CI -2.32 to 15.72, P < .00001, P = .15), but no difference between experimental group and control group.

CONCLUSION

We found that NO inhalation can improve oxygenation and reduce rate of death and use of ECMO in this meta-analysis. Therefore, we recommend the use of NO inhalation for infants born at or near term with respiratory failure.

摘要

背景

分子研究表明，一氧化氮（NO）是调节肺动脉张力的重要因素。然而，现有临床研究的结论并不一致。

目的

本荟萃分析旨在确定吸入NO是否能改善氧合，降低死亡率和体外膜肺氧合（ECMO）的使用率。

方法

检索策略用于搜索PubMed、Cochrane图书馆中的Cochrane对照试验中央登记册、Embase、科学网、临床试验注册中心和中国生物医学光盘，检索时间从开始至2018年2月。主要结局包括死亡或使用ECMO、出院前死亡、出院前使用ECMO、治疗后动脉血氧分压（PaO2）的变化。我们根据Cochrane手册评估每项纳入研究的偏倚风险，并计算相对危险度（RR）的典型估计值及其95%置信区间（CI），对于连续性结局，计算加权均数差（WMD）或标准化均数差（SMD）的汇总估计值及其95%CI。

结果

本荟萃分析纳入了9项随机对照试验（RCT），共856名参与者。该荟萃分析显示，与对照组相比，试验组的死亡或使用ECMO发生率显著降低（RR 0.66，95%CI 0.57 - 0.77，I² = 0%，P <.00001），出院前ECMO的使用率也较低（RR 0.89，95%CI 0.50 - 0.71，I² = 0%，P <.00001）。在无膈疝的婴儿中，试验组治疗后PaO2的变化显著更高（MD 50.40，95%CI 32.14 - 68.66，P <.00001）。荟萃分析还显示出院前死亡有改善趋势（RR 0.89，95%CI 0.60 - 1.31，I² = 0%，P =.55），膈疝婴儿治疗后PaO2的变化也有改善趋势（MD 6.70，95%CI -2.32至15.72，P <.00001，P =.15），但试验组与对照组之间无差异。