| Objective:To evaluate the safety and efficacy of LISA compared with INSURE as the drugdeliver way of pulmonary surfactant for neonatal respiratory distress syndrome(NRDS)by META analysis,in order to give evidence for select best drug-deliver way.Materials and methods:The PubMed,Wan Fng Data,The Cochrane Library,VIP,CJFD and CBMdisc were searched,and the published time was from database establishment to database establishment until December 31,2020.All the domestic and foreign clinical control studies on LISA vs.Insure method as pulmonary surfactant administration method in the treatment of neonatal respiratory distress syndrome,The rate of mechanical ventilation required within 72 hours,the mortality rate,the rate of second administration,the incidence of bradycardia and hypoxemia during administration were taken as statistics,and the incidence of bronchopulmonary dysplasia,degree Ⅲ to Ⅳ intraventricular hemorrhage,retinopathy of prematurity,pneumothorax and patent ductus arteriosus were also counted..The quality of accepted clinical articles was assessed.The relevant data were extracted for META analysis,funnel plot was used to evaluate publication bias,the possible causes of bias were analyzed,and sensitivity analysis was used to evaluate the stability of the results.Results:After retrieval and screening,a total of 12 studies were included,with the publication period from 2013 to 2020,and a total of 1577 children with NRDS participated in the experiment,including LISA treatment group 582 examples,INSURE treatment group 574 examples.The following is the outcome indicator analysis:1.Main outcome indicators: the odds ratio(OR)of mechanical ventilation required within 72 hours is 0.61,95% ci(0.46,0.81),the P value is 0.0006.It suggested that mechanical ventilation rate of LISA group was low within 72 hours in Insure group,and the difference is statistically significant.The OR of mortality is0.59,95%ci(0.39,0.89)and P value is 0.01,the difference is statistically significant.The OR value of the second administration rate is 1.20,95% ci(0.89,0.162)and P value 0.23,show that the difference is not statistically significant.2.Secondary outcome indicators of the two groups:The OR value of rate during administration is0.22,95% ci [0.11,0.46],and P value <0.0001,suggesting that the hypoxemia rate of LISA group is lower than that of INSURE group,and the difference is statistically significant.The OR value of bradycardia rate during administration is 0.14,95% ci[0.06,0.37],and P value <0.0001,suggesting that the bradycardia rate of LISA group is lower than that of INSURE group,and the difference was statistically significant.The OR and 95% ci of the incidence of BPD is 0.62(0.46,0.83),and the P value is0.001,indicate that the incidence of BPD in LISA group is lower than that in INSURE group,and the difference is statistically significant.The OR and 95% ci of the incidence of PDA is 0.70(0.51,0.95),and the P value is 0.002,indicate that the incidence of PDA in LISA group is lower than that in INSURE group,and the difference is statistically significant.The OR and 95% confidence interval for the incidence of ROP is 0.73(0.45,1.19),with a P value of 0.21,suggest no statistically significant difference.The OR and 95% ci for the incidence of ventricular hemorrhage is 0.86(0.61,1.22),with a P value of 0.40,suggesting no statistical significance.The OR and 95% ci for the incidence of pneumothorax is 0.59(0.34,0.92),with a P value of 0.02,the difference is statistically significant.Conclusion:LISA technology is a safe and effective drug delivery technology.Compared with INSURE technology,the incidence of blood oxygen decrease and bradycardia is less during the operation,which can reduce the rate of mechanical ventilation and mortality at the early stage of treatment,as well as the incidence of BPD,pneumothorax and PDA.It does not increase the rate of secondary administration and the risk of intraventricular hemorrhage and ROP. |
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