目的 本研究收集了NeOProM团队发表的比较超早早产儿不同血氧饱和度预后的临床文献,并对其进行系统评价,试图寻找适合超早早产儿的血氧饱和度.方法 采用STATA 12.0软件,对NeOProM团队发表的文献进行Meta分析,分别比较在胎龄小于28周的超早早产儿中,高血氧饱和度组(91%~95%)和低血氧饱和度组(85%~89%)在出院前或18月龄前病死率、早产儿视网膜病(ROP)、新生儿坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)、脑室内出血(IVH)、动脉导管未闭(PDA)发生率等方面内容.结果 纳入3篇文献,包括4 919名超早早产儿,其中低血氧饱和度组患儿2 460例,高血氧饱和度组患儿2 459例.系统评价显示,与高血氧饱和度组患儿比较,低血氧饱和度组患儿出院前或18月龄前病死率的风险增加(RR:1.19,95%CI:1.05~1.35);ROP发生率降低(RR:0.73,95%CI:0.53~1.00);NEC发生率增高(RR:1.26,95%CI:1.06~1.49);BPD、IVH及PDA发生率两组比较差异无统计学意义.结论 维持低血氧饱和度能降低超早早产儿ROP的发生率,但增加了超早早产儿病死率及NEC的发生率.
Abstract
Objective To explore an optimal oxygen saturation for extremely preterm infants based on a systemic review of the published studies. Methods A Meta analysis of the published studies by the NeOProM Group which compared the outcomes of extremely preterm infants (gestational age < 28 weeks) maintained in either a low (85%-89%) or high (91%-95%) oxygen saturation (SpO2) by using the STATA 12.0. The outcomes measured included the mortality and the incidences of retinopathy of prematurity (ROP), necrotizing enterocolitis of newborn (NEC), broncho-pulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and patent ductus arteriosus (PDA). Results Three studies were included, in which 2 460 infants were assigned into the low SpO2 group and 2 459 infants in the high SpO2 group. The Meta analysis demonstrated that the risk of mortality before discharge or at the age of 18 months increased in the low SpO2 group compared with the high SpO2 group (RR: 1.19; 95%CI: 1.05-1.35); the risk of ROP decreased in the low SpO2 group (RR: 0.73; 95%CI: 0.53-1.00); the risk of NEC increased in the low SpO2 group (RR: 1.26; 95%CI: 1.06-1.49). There was no significance in the incidences of BPD, IVH and PDA between the two groups. Conclusions Maintaining SpO2 at 85%-89% may decrease the incidence of ROP, but increase the mortality rate and the incidence of NEC in extremely premature infants.
关键词
血氧饱和度 /
Meta分析 /
预后 /
超早早产儿
Key words
Oxygen saturation /
Meta analysis /
Outcome /
Extremely preterm infant
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