纳络酮佐治新生儿缺氧缺血性脑病临床效果的Meta分析

Meta analysis of the therapeutic effect of naloxone on neonatal hypoxic ischemic encephalopathy

摘要:

临床上已用纳络酮 (naloxone)佐治新生儿缺氧缺血性脑病 (hypoxicischemicencephalopathy ,HIE) ,但对其疗效存在着争议。该文采用Meta分析方法综合评价纳络酮治疗新生儿HIE的有效性。方法 采用Meta分析 ,对满足条件的 2 0篇有关纳络酮治疗新生儿缺氧缺血性脑病效果对照研究的病例进行定性、定量综合评估 ,得出合并后的疗效和不良反应的比值比 (OR)及其 95 %的可信区间 (CI)。结果 在HIE常规治疗基础上 ,加用纳络酮治疗 ,可使患儿临床症状明显好转 (合并OR值 =4 .89,95 %CI为 2 .5 9～ 9.2 1 ) ,明显缩短中枢性呼吸衰竭时间 (合并OR值 =1 1 .0 9,95 %CI为 5 .1 3～ 2 3.98)、胃肠功能衰竭时间 (合并OR值 =4 4 .5 8,95 %CI为 1 8.4 2～1 0 7.93)和循环不良消失时间 (合并OR值 =5 .5 4 ,95 %CI为 2 .97～ 1 0 .35 ) ,并提高其存活率 (合并OR值 =3.38,95 %CI为 2 .0 1～ 5 .71 )。结论 在HIE常规治疗的基础上加用纳络酮 ,可显著改善HIE患儿病情 ,提高患儿的存活率。

Abstract:

Naloxone as an assist drug has been used to treat neonatal hypoxic ischemic encephalopathy (HIE). However, there is controversy about its therapeutic effect. This study aims to evaluate the effect by Meta analysis. Methods Using the Meta analysis method, 20 case control studies about the effect of naloxone on neonatal HIE were qualitatively and quantitatively analysed, and the combined OR value and 95% confidence interval (CI) of curative effects and side effects were calculated. Results Compared with the routine therapy, the therapy with naloxone can significantly improve clinical symptoms of neonates with HIE(combined OR= 4.89 , 95% CI= 2.59 - 9.21 ). Also, it can significantly shorten the time of respiratory failure (combined OR= 11.09 , 95% CI= 5.13 - 23.98 ), gastro intestine function failure (combined OR= 44.58 , 95% CI= 18.42 - 107.93 ) and circulatory system dysfunction (combined OR= 5.54 , 95% CI= 2.97 - 10.35 ), and increase the survival rate (combined OR= 3.38 , 95% CI 2.01 - 5.71 ). Conclusions The therapy with naloxone can markedly improve the severity and increase the survival rate of neonates with HIE.