Wu J, Wen Z H, Liu D D, Wu C F, Zhang Y, Zhang L, Xu Y L, Yang G, Jing C X
Department of Epidemiology and Health Statistics, School of Basic Medical Sciences, Jinan University, Guangzhou 510632, China; Department of Pathogenic Biology, Jinan University, Guangzhou 510632, China.
Department of Epidemiology and Health Statistics, School of Basic Medical Sciences, Jinan University, Guangzhou 510632, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Feb 10;41(2):249-260. doi: 10.3760/cma.j.issn.0254-6450.2020.02.020.
To evaluate the relative safety of different ventilation methods regarding mortality and rates of complication, on neonatal respiratory distress syndrome (NRDS). Network Meta-analysis was used to collect data on randomized controlled trials of pulmonary ventilation strategies in preterm infants with a mean gestational age of less than 32 weeks. Diagnostic criteria on NRDS were published in the PubMed, Cochrane, Web of Science, EBSCO, and Springer Link databases from January 1986 to June 2018. Revman 5.3 software was used to evaluate the quality of studies, based on the Cochrane quality assessment tool. Data were analyzed by Bayesian and frequency methods, using both Win BUGS 1.4.3 and STATA 13.0 software. Safety of different ventilation strategies for NRDS mortality and complications would include intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA) and retinopathy of prematurity (ROP) and were evaluated. Counted data was displayed by and 95. A total of 31 RCTs were included in this paper, including 5 827 preterm infants and 11 ventilation strategies. There were no statistically significant differences appearing in 11 ventilation strategies on mortality, PDA or ROP. IVH results were reported in 28 studies. Compared with nasal intermittent positive pressure ventilation (NIPPV), both high- frequency oscillation ventilation (HFOV) (=3.33, 95: 1.08-16.67, <0.05) and synchronized intermittent mechanical ventilation (SIMV) (=8.22, 95: 1.25-29.44, <0.05) schemes seemed to have increased the risk of IVH in preterm infants with NRDS. NIPPV appeared the optimal ventilation strategy in the rankings of cumulative probability. Results on clustering showed that NIPPV was probably the best ventilation strategy for children with NRDS after considering the orders of IVH, PDA and ROP on mortality, respectively. However, HFOV, IMV, and SIMV did not seem to be the ideal ventilated strategies. Most of the clinical decision makers might prefer using NIPPV in the treatment of children with NRDS through mechanical ventilation systems to reduce both the incidence and death caused by IVH, PDA and ROP. It was not recommended to use HFOV, SIMV and IMV in treating NRDS with gestational less than 32 weeks. We suggested that larger numbers of multi-center RCTs ba carried out to make the above conclusions more convincing.
为评估不同通气方法对新生儿呼吸窘迫综合征（NRDS）死亡率和并发症发生率的相对安全性。采用网状Meta分析收集平均胎龄小于32周的早产儿肺通气策略随机对照试验的数据。1986年1月至2018年6月期间，在PubMed、Cochrane、科学网、EBSCO和施普林格链接数据库中发布了NRDS的诊断标准。基于Cochrane质量评估工具，使用Revman 5.3软件评估研究质量。采用贝叶斯和频率方法，使用WinBUGS 1.4.3和STATA 13.0软件对数据进行分析。评估了不同通气策略对NRDS死亡率和并发症（包括脑室内出血（IVH）、动脉导管未闭（PDA）和早产儿视网膜病变（ROP））的安全性。计数数据以 和95显示。本文共纳入31项随机对照试验，包括5827例早产儿和11种通气策略。11种通气策略在死亡率、PDA或ROP方面无统计学显著差异。28项研究报告了IVH结果。与鼻塞间歇性正压通气（NIPPV）相比，高频振荡通气（HFOV）（ =3.33，95%：1.08 - 16.67，<0.05）和同步间歇机械通气（SIMV）（ =8.22，95%：1.25 - 29.44，<0.05）方案似乎增加了NRDS早产儿发生IVH的风险。在累积概率排名中，NIPPV似乎是最佳通气策略。聚类结果显示，分别考虑IVH、PDA和ROP对死亡率的影响顺序后，NIPPV可能是NRDS患儿的最佳通气策略。然而，HFOV、IMV和SIMV似乎不是理想的通气策略。大多数临床决策者可能更倾向于在通过机械通气系统治疗NRDS患儿时使用NIPPV，以降低IVH、PDA和ROP所致的发病率和死亡率。不建议在治疗胎龄小于32周的NRDS时使用HFOV、SIMV和IMV。我们建议开展更多多中心随机对照试验，以使上述结论更具说服力。
