Rong Hui, Bao Ying, Wen Zunjia, Chen Xiuli, Chen Cen, Li Fang
NICU.
Nursing department, Children's Hospital of Nanjing Medical University, China.
Medicine (Baltimore). 2020 Nov 25;99(48):e23113. doi: 10.1097/MD.0000000000023113.
Pulmonary surfactant (PS) is commonly used for the treatment of neonatal respiratory distress syndrome (NRDS), several randomized controlled trials (RCTs) have evaluated the role of nebulized versus invasively delivered PS, yet the results remained inconsistent. Therefore, we aimed to conduct this meta-analysis to evaluate the effects and safety of nebulized versus invasively delivered PS in the treatment of NRDS.
We searched PubMed et al databases from inception date to May 15, 2020 for RCTs that compared nebulized vs invasively delivered PS. Two authors independently screened the studies and extracted data from the published articles. Summary odd ratios (OR) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated for each outcome by means of fixed- or random-effects model.
Two RCTs with a total of 95 preterm neonates were identified, with 48 neonates received PS nebulization and 47 neonates undergone invasive PS administration. There was no significant difference in the SpO2 level (MD = -0.44, 95% CI -6.01 to 5.12) and the A/APaO2 level (MD = 0.01, 95% CI -0.02 to 0.05) 1 hour after treatment among 2 groups. But the duration of mechanical ventilation in the nebulization groups was significantly less than that of invasive group (MD = -30.70, 95% CI -41.45 to 19.95).
Given the limited evidences, the effects and safety of nebulized versus invasively delivered PS still need further verification.
肺表面活性物质（PS）常用于治疗新生儿呼吸窘迫综合征（NRDS），多项随机对照试验（RCT）评估了雾化吸入与侵入性给予PS的作用，但结果仍不一致。因此，我们旨在进行这项荟萃分析，以评估雾化吸入与侵入性给予PS治疗NRDS的效果和安全性。
我们检索了从起始日期至2020年5月15日的PubMed等数据库，以查找比较雾化吸入与侵入性给予PS的RCT。两位作者独立筛选研究并从已发表的文章中提取数据。通过固定效应或随机效应模型为每个结局计算汇总比值比（OR）或平均差（MD）及其95%置信区间（CI）。
共纳入两项RCT，总计95例早产儿，其中48例接受PS雾化吸入，47例接受侵入性PS给药。两组治疗1小时后的SpO2水平（MD = -0.44，95%CI -6.01至5.12）和A/APaO2水平（MD = 0.01，95%CI -0.02至0.05）无显著差异。但雾化吸入组的机械通气时间显著短于侵入性给药组（MD = -30.70，95%CI -41.45至19.95）。
鉴于证据有限，雾化吸入与侵入性给予PS的效果和安全性仍需进一步验证。
