中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2010年
6期
488-493
,共6页
婴儿,早产%动脉导管未闭%布洛芬%Meta分析
嬰兒,早產%動脈導管未閉%佈洛芬%Meta分析
영인,조산%동맥도관미폐%포락분%Meta분석
Infant,premature%Ductus arteriosus,patent%Ibuprofen%Meta-analysis
目的 评价早产儿静脉预防性应用布洛芬对动脉导管未闭(patent ductus arteriosus,PDA)的有效性及安全性.方法 计算机检索PubMed、ScienceDirect、EMBASE、OVID、Cochrane 图书馆、维普中文科技期刊数据库、中国学术期刊网全文数据库,并手工检索作为补充,收集静脉预防性应用布洛芬对早产儿PDA影响的随机对照试验(randomized controlled trial,RCT)并进行筛选和质量评价,采用RevMan 5.0.21软件进行meta分析,计量资料采用加权均数差(weighted mean difference,WMD)及其95%CI表示,计数资料采用相对危险度(risk ratio,RR)及其95%CI表示.结果 最终纳入文献4篇,其中3篇文献Jadad评分为4分,1篇文献为3分.Meta分析结果示:(1)静脉预防性应用布洛芬可以减少早产儿第3天动脉导管未关闭的风险(RR=0.40,95%CI:0.31～0.51,P＜0.01)、需环氧酶抑制剂再治疗以关闭动脉导管(RR=0.18,95%CI:0.07～0.45,P=0.0003)及需外科结扎以关闭动脉导管(RR=0.34,95%CI:0.14～0.81,P=0.02).(2)就目前数据而言,本meta分析未发现静脉预防性应用布洛芬对早产儿肺、脑、胃肠、肾等系统产生显著不良影响.结论 早产儿静脉预防性应用布洛芬可显著减少生后第3天动脉导管未关闭、需环氧酶抑制剂再治疗以关闭动脉导管和外科结扎关闭动脉导管,且短期内未见明显不良影响,但现有证据尚不足以推荐临床静脉预防性应用布洛芬防治早产儿PDA.
目的 評價早產兒靜脈預防性應用佈洛芬對動脈導管未閉(patent ductus arteriosus,PDA)的有效性及安全性.方法 計算機檢索PubMed、ScienceDirect、EMBASE、OVID、Cochrane 圖書館、維普中文科技期刊數據庫、中國學術期刊網全文數據庫,併手工檢索作為補充,收集靜脈預防性應用佈洛芬對早產兒PDA影響的隨機對照試驗(randomized controlled trial,RCT)併進行篩選和質量評價,採用RevMan 5.0.21軟件進行meta分析,計量資料採用加權均數差(weighted mean difference,WMD)及其95%CI錶示,計數資料採用相對危險度(risk ratio,RR)及其95%CI錶示.結果 最終納入文獻4篇,其中3篇文獻Jadad評分為4分,1篇文獻為3分.Meta分析結果示:(1)靜脈預防性應用佈洛芬可以減少早產兒第3天動脈導管未關閉的風險(RR=0.40,95%CI:0.31～0.51,P＜0.01)、需環氧酶抑製劑再治療以關閉動脈導管(RR=0.18,95%CI:0.07～0.45,P=0.0003)及需外科結扎以關閉動脈導管(RR=0.34,95%CI:0.14～0.81,P=0.02).(2)就目前數據而言,本meta分析未髮現靜脈預防性應用佈洛芬對早產兒肺、腦、胃腸、腎等繫統產生顯著不良影響.結論 早產兒靜脈預防性應用佈洛芬可顯著減少生後第3天動脈導管未關閉、需環氧酶抑製劑再治療以關閉動脈導管和外科結扎關閉動脈導管,且短期內未見明顯不良影響,但現有證據尚不足以推薦臨床靜脈預防性應用佈洛芬防治早產兒PDA.
목적 평개조산인정맥예방성응용포락분대동맥도관미폐(patent ductus arteriosus,PDA)적유효성급안전성.방법 계산궤검색PubMed、ScienceDirect、EMBASE、OVID、Cochrane 도서관、유보중문과기기간수거고、중국학술기간망전문수거고,병수공검색작위보충,수집정맥예방성응용포락분대조산인PDA영향적수궤대조시험(randomized controlled trial,RCT)병진행사선화질량평개,채용RevMan 5.0.21연건진행meta분석,계량자료채용가권균수차(weighted mean difference,WMD)급기95%CI표시,계수자료채용상대위험도(risk ratio,RR)급기95%CI표시.결과 최종납입문헌4편,기중3편문헌Jadad평분위4분,1편문헌위3분.Meta분석결과시:(1)정맥예방성응용포락분가이감소조산인제3천동맥도관미관폐적풍험(RR=0.40,95%CI:0.31～0.51,P＜0.01)、수배양매억제제재치료이관폐동맥도관(RR=0.18,95%CI:0.07～0.45,P=0.0003)급수외과결찰이관폐동맥도관(RR=0.34,95%CI:0.14～0.81,P=0.02).(2)취목전수거이언,본meta분석미발현정맥예방성응용포락분대조산인폐、뇌、위장、신등계통산생현저불량영향.결론 조산인정맥예방성응용포락분가현저감소생후제3천동맥도관미관폐、수배양매억제제재치료이관폐동맥도관화외과결찰관폐동맥도관,차단기내미견명현불량영향,단현유증거상불족이추천림상정맥예방성응용포락분방치조산인PDA.
Objective To determine the effectiveness and safety of prophylactic intravenous ibuprofen compared to placebo/no intervention on the prevention of patent ductus arteriosus(PDA) in preterm infants.Methods Randomized controlled trials(RCT) or quasi-RCT comparing prophylactic intravenous ibuprofen versus placebo/no treatment for prevention of PDA in preterm infants were enrolled. The standard search strategy included electronic search and manual search. Electronic search was carried out in databases including PubMed,ScienceDirect, EMBASE, OVID, Cochrane Library, VIP Chinese Periodical Database and Chinese Digital Hospital Library (www. chkd. cnki. net) without language restriction. As a supplementation,references in previous reviews and studies identified as relevant had been examined by manual search. RevMan 5.0. 21 was used in the statistical analysis. Effects were expressed as weighted mean difference (WMD) and 95% confidence interval (CI) for continuous data while risk ratio (RR) and 95%CI for categorical data.Results Four studies qualified for this meta-analysis including three graded 4 and one graded 3 with Jadad scale. Prophylactic use of ibuprofen significantly decreased the incidence of PDA on day three (RR=0. 40,95 % CI: 0. 31-0. 51, P＜0.01 ), the need for rescue treatment with cyclo-oxygenase inhibitors (RR = 0. 18,95 % CI:0. 07-0. 45, P = 0. 0003) and the need for surgical ligation (RR = 0. 34,95 % CI: 0. 14-0. 81, P =0. 02) in the prophylactic group. No significant difference of pulmonary, cerebral, gastrointestinal, and renal complications were found between the prophylactic and control groups. Conclusions Prophylactic intravenous ibuprofen significantly reduces the risk of PDA on day three, decreases the need for rescue treatment with cyclo-oxygenase inhibitors and surgical ligation without significant pulmonary, cerebral,gastrointestinal, and renal complications were seen in the prophylactic group. Due to the limits of evidences to date, prophylactic ibuprofen intravenously for prevention of PDA in preterm infants is not recommended.
