猪肺表面活性物质与牛肺表面活性物质治疗新生儿呼吸窘迫综合征疗效比较的Meta分析

目的：系统比较猪肺表面活性物质（PS）与牛PS治疗新生儿呼吸窘迫综合征（NRDS）的有效性和安全性。方法：检索CNKI、VIP、Wanfang、EMBase、the Cochrane Library、PubMed等数据库，收集猪PS与牛PS治疗NRDS的随机对照试验（RCT），检索时限从建库至2019年6月。两名研究者独立完成文献筛选、数据提取和质量评估，采用RevMan 5.3和Stata 12.0软件进行Meta分析。结果：共纳入22项研究，共计2 351例患儿。Meta分析结果显示，猪PS组的病死率、重新给予PS率、氧暴露时间及气漏、支气管肺发育不良（BPD）、动脉导管未闭（PDA）的发生率均低于牛PS组，而72 h拔管率高于牛PS组（P均<0.05）；两组患儿肺出血、败血症、住院时间、新生儿坏死性小肠结肠炎（NEC）、呼吸机相关性肺炎（VAP）发生率比较差异均无统计学意义（P均>0.05）。结论：现有证据表明，与牛PS相比，猪PS治疗NRDS更能有效降低病死率、重新给予PS率，提高72 h拔管率，缩短氧暴露时间，且并发症发生的风险较小。但受纳入样本量和文献质量限制，需进一步开展大规模高质量RCT加以验证。

Meta-Analysis on Efficacy of Porcine and Bovine Pulmonary Surfactant in the Treatment of Neonatal Respiratory Distress Syndrome

Objective: To systematically compare the efficacy and safety of porcine and bovine pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods: CNKI, VIP, Wanfang data, EMBase, the Cochrane Library and PubMed database were retrieved to collect the randomized controlled trials (RCT) of porcine and bovine PS in the treatment of NRDS. The retrieval time was from the establishment of the database to Jun. 2019. Two investigators independently performed literature screening, data extraction and quality assessment, and Meta-analysis was performed by using RevMan 5.3 and Stata 12.0 software. Results: A total of 22 RCT were collected, including 2,351 children. Meta-analysis showed that the mortality rate, re-administration rate of PS, oxygen exposure time and air leakage, bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) of the porcine PS group were lower than those of the bovine PS group, the extubation rate at 72 h was higher than that of the bovine PS group (P<0.05). The differences in the incidence of pulmonary hemorrhage, sepsis, length of stay, neonatal necrotizing enterocolitis (NEC) and ventilator-associated pneumonia (VAP) were not statistically significant between two groups (P>0.05). Conclusion: Available evidence suggests that compared with bovine PS, porcine PS for NRDS is more effective in reducing the mortality rate and re-administration rate of PS, increasing the extubation rate at 72 and shortening the oxygen exposure time, with a lower risk of complications. Further large scale, high quality RCT are needed for validation due to the limitations of the included sample size and quality of the literature.