磷酸肌酸钠治疗新生儿窒息后心肌损伤的meta分析

Treatment of myocardial damage with creatine phosphate following neonatal asphyxia: a meta-analysis

摘要:

目的：评价磷酸肌酸钠治疗新生儿窒息后心肌损伤的疗效。方法：检索国内外相关数据库，搜集有关磷酸肌酸钠治疗新生儿窒息合并心肌损伤的随机及半随机对照试验，采用Review Manager 5.1软件对数据进行分析。结果：共纳入6篇文献，400例患儿（试验组202例，对照组198例）。meta分析结果显示磷酸肌酸钠治疗7 d后患儿心肌酶CK、CK-MB、LDH、HBDH、cTnI均有所下降。治疗组显效率和总有效率均高于对照组，相对危险度分别为1.78和1.29，95%CI为（1.32，2.41）和（1.12，1.48）。治疗组总住院天数较对照组少4.07 d，95%CI为（-5.25，-2.89）。结论：磷酸肌酸钠对于治疗新生儿窒息后的心肌损伤显效率及总有效率均高于对照组，能缩短住院天数，且心肌酶谱可出现下降，未发现严重不良反应。但由于所纳入试验质量原因，需要更多的随机对照试验来验证。

Abstract:

OBJECTIVE: To evaluate the effects of creatine phosphate (CP) in the treatment of myocardial damage following neonatal asphyxia. METHODS: Medical databases were searched for a systematic literature review and meta-analysis of randomized and quasi-randomized trials on the treatment of myocardial damage with CP following neonatal asphyxia. The data was analyzed using Review Manager 5.1. RESULTS: Six trials involving 400 patients (CP treatment/control: 202/198) were included in the survey. The meta-analysis indicated that CP treatment for 7 days decreased serum myocardial enzyme levels (CK, CK-MB, LDH, HBDH and cTnI levels). Both the total effective rate (RR: 1.29; 95% CI: 1.12, 1.48) and the significantly effective rate (RR: 1.78; 95% CI: 1.32, 2.41) in the CP treatment group were significantly higher than in the control group. CP treatment reduced the hospitalization period by 4.07 days compared with the control group (95% CI: -5.25, -2.89). CONCLUSIONS: CP treatment appears to be more effective than routine treatment alone for myocardial damage following neonatal asphyxia. It appears to be safe and it can both decrease serum myocardial enzyme levels and shorten the period of hospitalization. However, as the evidence obtained in this study is not robust due to the poor quality of current studies, further studies of high-quality, large-scale trails are needed.