低侵入性肺表面活性物质治疗技术治疗新生儿呼吸窘迫综合征有效性和安全性的Meta分析

目的 系统评价低侵入性肺表面活性物质治疗（LISA）技术在新生儿呼吸窘迫综合征（NRDS）中的有效性及安全性。方法 计算机检索PubMed、Cochrane图书馆、Embase、中国生物医学文献数据库、中文科技期刊数据库（维普）、中国知网和万方数据库等，检索关于使用LISA技术治疗NRDS的随机对照试验（RCT）研究。依据文献纳入和排除标准进行文献筛选和质量评价。采用Review Manager 5.3统计软件进行Meta分析。结果 共纳入9项RCT研究，合计1 212例NRDS患儿，其中试验组（使用LISA技术）611例，对照组（使用INSURE技术）601例。Meta分析结果显示：使用LISA技术降低了NRDS患儿生后72 h内机械通气率（OR=0.39，95%CI：0.29~0.51，P < 0.001）、支气管肺发育不良发生率（OR=0.53，95%CI：0.38~0.72，P < 0.001）及气胸发生率（OR=0.56，95%CI：0.33~0.93，P=0.02）。两组患儿病死率及其他新生儿疾病的发生率比较差异均无统计学意义（P > 0.05）。两组需要重复使用PS发生率比较差异无统计学意义（P > 0.05），用LISA技术观察到的PS反流发生率更高（OR=2.60，95%CI：1.64~4.12，P < 0.001）。结论 与INSURE技术相比，LISA技术在减少NRDS患儿对机械通气需求，降低支气管肺发育不良及气胸的发生率方面具有优势。

Efficacy and safety of less invasive surfactant administration in the treatment of neonatal respiratory distress syndrome: a Meta analysis

Objective To evaluate the efficacy and safety of less invasive surfactant administration (LISA) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods PubMed, Cochrane Library, Embase, China Biology Medicine disc, China Scientific Journal Database, CNKI Database, and Wanfang Database were searched for randomized controlled trials (RCTs) on the use of LISA strategy in the treatment of NRDS. Literature screening and quality assessment were performed according to inclusion and exclusion criteria. Review Manager 5.3 software was used to perform the Meta analysis. Results A total of 9 RCTs were included, with a total of 1 212 children with NRDS. There were 611 children in the experimental group (treated with LISA strategy) and 601 children in the control group[treated with intubation-surfactant-extubation (INSURE) strategy]. The Meta analysis showed that the use of LISA strategy reduced the rate of mechanical ventilation within 72 hours after birth (OR=0.39, 95% CI:0.29-0.51, P < 0.001) and the incidence rates of bronchopulmonary dysplasia (OR=0.53, 95% CI:0.38-0.72, P < 0.001) and pneumothorax (OR=0.56, 95% CI:0.33-0.93, P=0.02). There were no significant differences in the mortality rate and incidence rates of other neonatal diseases between the two groups (P > 0.05). There was no significant difference in the rate of repeated use of pulmonary surfactant (PS) between the two groups (P > 0.05), but there was a higher incidence rate of PS reflux observed by LISA strategy (OR=2.60, 95% CI:1.64-4.12, P < 0.001). Conclusions Compared with INSURE strategy, LISA strategy has advantages in reducing the need for mechanical ventilation and the incidence rates of bronchopulmonary dysplasia and pneumothorax in children with NRDS.