血氧饱和度对超早早产儿预后影响的Meta分析

What is the optimal oxygen saturation for extremely premature infants? A Meta analysis

摘要:

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.