新生儿呼吸窘迫综合征防治的临床证据

目的评价预防和治疗早产儿呼吸窘迫综合征(RDS)的有效性和安全性。方法应用国际Cochrane协作网的系统评价方法对有关RDS预防及治疗的随机和半随机对照试验进行了系统评价。结果(1)肺表面活性物质(PS)能降低新生儿死亡率(RR0·87,95%CI0·77,0·99)和气胸发生率(RR0·7,95%CI0·59,0·82)。(2)出生前给予其母亲激素治疗可明显降低RDS发生率及新生儿死亡率、且无明显副作用。(3)持续性肺扩张压(CDP)可减少死亡率(RR0·52,95%CI0·32,0·87,NNT=7)和减少间歇性正压通气的使用(RR0·70,95%CI0·55,0·88,NNT=5)。高频喷射通气(HFJV)可减少慢性肺疾病(CLD)的发生率(RR0·58,95%CI0·34,0·98,NNT=7)。结论(1)PS预防和治疗RDS有效。(2)产前给予皮质激素,可降低RDS发生率。(3)应用CDP、HFJV治疗RDS有效,可减少呼吸衰竭及CLD的发生率。

Clinical evidence for prevention and treatment to neonatal respiratory distress syndrome

Objective To assess the efficacy and safety of the prevention and the treatment in neonate respiratory distress syndrome (NRDS). Methods Randomized controlled trials and quasi-randomized controlled trials regarding the prevention and the treatment of NRDS were searched and systematically reviewed by the ways of international Cochrane Collaboration. Results (1) Pulmonary surfactant (PS) supplementation can reduce not only neonatal mortality and morbidity, but also the risk of pneumothorax. (2)Prenatal corticosteroids given to women at risk of preterm birth can decrease morbidity of NRDS and neonatal mortality without significant adverse effect. (3) Continuous distending pressure (CDP) can decrease neonatal mortality and shorten the duration on positive airway pressure ventilation. There is less chronic lung disease (CLD) in high frequency jet ventilation (HFJV). Conclusions (1) PS administration has good efficiency in the prevention and treatment of NRDS. (2) Corticosteroids given to women at risk of preterm birth can reduce morbidity of NRDS and neonatal mortality. (3) CDP and HFJV can reduce neonatal mortality and the incidence of respiratory failure and CLD.