中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2008年
2期
101-106
,共6页
汤亚南%赵凤临%陈白羽%王波
湯亞南%趙鳳臨%陳白羽%王波
탕아남%조봉림%진백우%왕파
缺氧缺血,脑%低温,人工%婴儿,新生%随机对照试验%Meta分析
缺氧缺血,腦%低溫,人工%嬰兒,新生%隨機對照試驗%Meta分析
결양결혈,뇌%저온,인공%영인,신생%수궤대조시험%Meta분석
Hypoxia-ischemia,brain%Hypothermia,induced%Infant,newborn%Randomized controlled trials%Meta-analysis
目的 评价亚低温对新生儿缺氧缺血性脑损伤的保护作用.方法 计算机检索Medline/PubMed(1977～2006年)医学数据库、荷兰医学文摘(Embase,1989～2006年)和OVID全文数据库、Cochrane系统评价数据库(2006年)、中国学术期刊网全文数据库(CNKI,1994～2006年)、中国生物医学文献数据库(CBMdisc,1978～2006年)和国家科技图书文献中心等文献数据库,收集亚低温治疗新生儿缺氧缺血性脑损伤的临床研究和系统评价,进行质量评价,并对符合纳入标准的临床研究进行Meta分析. 结果 共查阅到国内外相关临床研究18篇,纳入随机对照研究4篇,其中国外3篇,国内1篇,均为高质量研究(Jadad评分均为3分).纳入研究均描述了随机化方法,但均未使用盲法.各组研究随访12～18个月,报道了病死率和严重伤残的发生率,均描述了失访情况.合并分析表明,与普通治疗组比较,亚低温组病死率OR=0.64,95%CI为0.46～0.90,P=0.01;严重伤残发生率OR=0.57,95% CJ为0.37～0.86,P=0.008;严重伤残和病死的合并发生率OR=0.50,95% CI为0.36～0.69,P<0.01,差异均有统计学意义. 结论 从现有临床证据看,亚低温可降低新生儿缺氧缺血性脑损伤后严重伤残发生率和病死率,但仍需大规模、高质量、随访结局统一的临床试验进一步验证.
目的 評價亞低溫對新生兒缺氧缺血性腦損傷的保護作用.方法 計算機檢索Medline/PubMed(1977～2006年)醫學數據庫、荷蘭醫學文摘(Embase,1989～2006年)和OVID全文數據庫、Cochrane繫統評價數據庫(2006年)、中國學術期刊網全文數據庫(CNKI,1994～2006年)、中國生物醫學文獻數據庫(CBMdisc,1978～2006年)和國傢科技圖書文獻中心等文獻數據庫,收集亞低溫治療新生兒缺氧缺血性腦損傷的臨床研究和繫統評價,進行質量評價,併對符閤納入標準的臨床研究進行Meta分析. 結果 共查閱到國內外相關臨床研究18篇,納入隨機對照研究4篇,其中國外3篇,國內1篇,均為高質量研究(Jadad評分均為3分).納入研究均描述瞭隨機化方法,但均未使用盲法.各組研究隨訪12～18箇月,報道瞭病死率和嚴重傷殘的髮生率,均描述瞭失訪情況.閤併分析錶明,與普通治療組比較,亞低溫組病死率OR=0.64,95%CI為0.46～0.90,P=0.01;嚴重傷殘髮生率OR=0.57,95% CJ為0.37～0.86,P=0.008;嚴重傷殘和病死的閤併髮生率OR=0.50,95% CI為0.36～0.69,P<0.01,差異均有統計學意義. 結論 從現有臨床證據看,亞低溫可降低新生兒缺氧缺血性腦損傷後嚴重傷殘髮生率和病死率,但仍需大規模、高質量、隨訪結跼統一的臨床試驗進一步驗證.
목적 평개아저온대신생인결양결혈성뇌손상적보호작용.방법 계산궤검색Medline/PubMed(1977～2006년)의학수거고、하란의학문적(Embase,1989～2006년)화OVID전문수거고、Cochrane계통평개수거고(2006년)、중국학술기간망전문수거고(CNKI,1994～2006년)、중국생물의학문헌수거고(CBMdisc,1978～2006년)화국가과기도서문헌중심등문헌수거고,수집아저온치료신생인결양결혈성뇌손상적림상연구화계통평개,진행질량평개,병대부합납입표준적림상연구진행Meta분석. 결과 공사열도국내외상관림상연구18편,납입수궤대조연구4편,기중국외3편,국내1편,균위고질량연구(Jadad평분균위3분).납입연구균묘술료수궤화방법,단균미사용맹법.각조연구수방12～18개월,보도료병사솔화엄중상잔적발생솔,균묘술료실방정황.합병분석표명,여보통치료조비교,아저온조병사솔OR=0.64,95%CI위0.46～0.90,P=0.01;엄중상잔발생솔OR=0.57,95% CJ위0.37～0.86,P=0.008;엄중상잔화병사적합병발생솔OR=0.50,95% CI위0.36～0.69,P<0.01,차이균유통계학의의. 결론 종현유림상증거간,아저온가강저신생인결양결혈성뇌손상후엄중상잔발생솔화병사솔,단잉수대규모、고질량、수방결국통일적림상시험진일보험증.
Objective To assess the efficacy of mild hypothermia in treatment of neonatal hypoxic-ischemic brain injury. Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed among Medline/PubMed(1977～2006),Embase (1989～2006),OVID,Cochrane(2006),Chinese Digital Hospital Library(www.chkd.cnki.net)and Chinese Biomedical Literature Disk Database(CBMdisk).Quality assessments of clinical trials were carried out.Randomized controlled trials(RCTs)with fatality rate and the incidence rate of severe disability were selected for meta-analysis. Results A total of 725 patients involved in 4 papers which met the inclusion criteria were enrolled in this meta-analysis.Four RCTs with Jadad score was 3were included,3 papers were done in overseas and 1 papers was done in China.A11 of the 4 RCTs described the method of randomization and allocation concealment.But none of the 4 RCTs mentioned whether blindness was used.Comparing with the control group,the OR of the fatality rate in mild hypothermia group was 0.64 with 95%CI 0.46-0.90,P=0.01.The OR of the incidence rate of severe disability was 0.57 with 95%CI 0.37-0.86,P=0.008.The OR of the overall incidence rate of severe disability and death was 0.50 with 95%CI 0.36-0.69,P<0.01. Conclusions The clinical evidences available so far indicated that mild hypothermia could reduce the fatality rate and the incidence rate of severe disability resulted from neonatal hypoxic-ischemic brain iniury.The quality of most RCTs on mild hypothermia in China for HIE was not in good quality.Scientifically designed RCTs are still needed to evaluate the value of mild hypothermia in the treatment of HIE.
