双水平正压通气和经鼻持续气道正压通气治疗早产儿呼吸窘迫综合征的疗效和并发症Meta分析

目的 采用Meta分析的方法评价双水平正压通气(BiPAP）和经鼻持续气道正压通气（NCPAP）治疗早产儿呼吸窘迫综合征（RDS）的疗效和安全性。方法 计算机检索PubMed、Sciverse、Cochrane图书馆、中国知网、中国生物医学文献数据库、维普数据库及万方数据库，收集BiPAP和NCPAP治疗早产儿RDS的RCT文献。2名研究者根据纳入和排除标准独立筛选文献，应用RevMan 5.2软件进行Meta分析，比较BiPAP和NCPAP的治疗失败率、氧合情况和并发症发生率。结果 9篇RCT文献进入Meta分析，共纳入571例患儿，BiPAP 组289例，NCPAP组282例。Meta分析结果提示，BiPAP组治疗失败率低于NCPAP组,OR=0.42 （95%CI：0.20~0.89），按出生体重行亚组分析，极低出生体重儿（出生体重<1 500 g）的1篇文献两组治疗失败率差异无统计学意义,OR=1.49(95%CI:0.51~4.33）；BiPAP组较NCPAP组显著提高呼吸支持后12 h和24 h PaO2 ，MD分别为6.88 mmHg（95%CI：4.38~9.38)和6.36 mmHg(95%CI：4.80~7.92)；显著降低呼吸支持后12 h和24 h PaCO2，MD分别为-5.00 mmHg（95%CI：-5.75~-4.25)和-5.39 mmHg (95%CI:-6.18~-4.61)；两组病死率差异无统计学意义，OR=0.76（95%CI:0.34~1.69）。支气管肺发育不良、新生儿坏死性小肠结肠炎、脑室内出血、气胸、早产儿视网膜病变等并发症发生率BiPAP和NCPAP组差异均无统计学意义。结论 BiPAP治疗早产儿RDS疗效优于NCPAP，且并发症发生率与NCPAP相当，但BiPAP治疗极低出生体重儿的疗效仍需积累更多证据。

Comparison of efficacy and compliactions between bilevel positive airway pressure and nasal continuous positive airway pressure in the treatment of neonatal respiratory distress syndrome: a meta-analysis

Objective To evaluate the efficacy and complications between bilevel positive airway pressure (BiPAP) and nasal continuous positive airway pressure (NCPAP) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods Randomized controlled trials (RCTs) regarding comparison of efficacy and complications between BiPAP and NCPAP in NRDS were retrieved in PubMed, Sciverse, Cochrone Library, CNKI, CBM, VIP and Wanfang database. According to the inclu-sion and exclusion criteria, two reviewers independently screened the trials, extracted the data, assessed the quality, conducted the meta-analysis with RevMan 5.2 to evaluate the rate of failure, pressure of PaO2 or PaCO2 and the complications. Results A total of 9 RCTs were eligible for the study including 571 cases, 289 cases in BiPAP group and 282 cases in NCPAP group. Compared with NCPAP group, BiPAP group had a higher successful rate (OR=0.42, 95%CI: 0.20 to 0.89), however the successful rate did not differ siginificantly in one study, which included very low birth weight infants （OR=1.49,95%CI:0.51 to 4.33）. After 12 hours treatment, BiPAP group could significantly increase PaO2 (MD=6.88 mmHg, 95%CI: 4.38 to 9.38) and decrease PaCO2 (MD=-5.00 mmHg，95%CI：-5.75 to -4.25), and could significantly increase PaO2 (MD=6.36 mmHg, 95%CI: 4.80 to 7.92) and decrease PaCO2 (MD=-5.39 mmHg，95%CI：-6.18 to -4.61) after 24 hours with treatment. However, there was no statistical difference in death rate between NCPAP and BiPAP groups (OR=0.76，95%CI:0.34 to 1.69). The results showed that no difference existed in complications such as BPD, NEC, pneumothorax, horax, IVH, ROP between BiPAP and NCPAP groups. Conclusion The results indicated that BiPAP had inferior efficacy in NRDS, but no much difference in complications between BiPAP and NCPAP. The more evidence of efficacy of BiPAP is needed in very low birth weight infants.