米力农注射液治疗儿童先天性心脏病合并重症肺炎及心力衰竭的疗效与安全性的Meta分析

目的：系统评价米力农注射液治疗儿童先天性心脏病（CHD）合并重症肺炎及心力衰竭的疗效。方法：计算机检索PubMed、EMBase、the Cochrane Library、万方数据库、CBM、CNKI，收集有关应用米力农注射液治疗儿童CHD合并重症肺炎及心力衰竭的随机对照试验（对照组给予常规对症治疗+多巴胺注射液或洋地黄，试验组给予常规对症治疗+米力农注射液），检索时限均为建库至2018年8月。由2名评价者独立选择文献、提取资料和评估方法学质量后，采用Rev Man 5.3软件进行Meta分析，并使用Jadad系统评价质量。结果：共纳入5项随机对照试验，共398例患儿。与对照组比较，试验组总有效率（OR=1.25，95%CI：1.13~1.37，P<0.01）、心率平稳时间（SMD=-1.28，95%CI：-1.65~-0.91，P<0.01）、呼吸或咳嗽症状平稳时间（SMD=-2.18，95%CI：-4.02~-0.34，P=0.02）和心功能指标（LVEF）改善情况（SMD=1.14，95%CI：0.66~1.62，P<0.01）均具有明显优势。两组不良反应发生率比较差异无统计学意义（OR=1.31，95%CI：0.57~3.03，P=0.53）。结论：米力农治疗小儿CHD合并重症肺炎及心力衰竭可较快改善临床症状与心功能，提高总有效率。但由于文献质量的局限性，仍需大样本双盲随机试验的证据支持

Meta-Analysis of Efficacy and Safety of Milrinoneon Injection in the Treatment of Children with Congenital Heart Disease Complicated with Severe Pneumonia and Heart Failure

Objective: To systematically review the efficacy of milrinoneon injection in the treatment of children with congenital heart disease (CHD) complicated with severe pneumonia and heart failure. Methods: PubMed, EMBase, the Cochrane Library, Wanfang database, CBM and CNKI were retrieved to collect the randomized controlled trials (RCT) of milrinoneon injection in the treatment of children with CHD complicated with severe pneumonia and heart failure (the control group was given conventional symptomatic treatment + dopamine injection or digitalis, while the experimental group received conventional symptomatic treatment + milrinone injection). The retrieval time was from the establishment of the database to Aug. 2018. Two reviewers independently selected the literature, extracted the data and evaluated the methodological quality, Meta-analysis was performed by using RevMann 5.3 software, and the quality of evidence was evaluated with the Jadad system. Results: A total of 5 RCT were enrolled, including 398 patients. Compared with the control group, the total effective rate (OR=1.25, 95%CI from 1.13 to 1.37, P<0.01), the stable time of heart rate (SMD=-1.28, 95%CI from -1.65 to -0.91, P<0.01), the stable time of respiratory or cough symptoms (SMD=-2.18, 95%CI from -4.02 to -0.34, P<0.05) and the cardiac function index (LVEF) (SMD=1.14, 95%CI from 0.66 to 1.62, P<0.01) had significant advantages in the experimental group. There was no significant difference in the incidence of adverse drug reactions between two groups (OR=1.31, 95%CI from 0.57 to 3.03, P>0.05). Conclusion: Milrinone in the treatment of children with CHD complicated with severe pneumonia and heart failure may improve clinical symptoms and cardiac function more rapidly and increase the overall efficiency. However, due to limitations in the quality of the literature, evidence from double-blind randomized trials with large samples is still needed