论文部分内容阅读
目的:系统评价产房心肺复苏（cardiopulmonary resuscitation in the delivery room，DR-CPR）对极低/超低出生体重儿（very/extremely low birth weight infant，VLBWI/ELBWI）近远期临床结局的影响。方法:计算机检索PubMed、Embase、Cochrane图书馆、中国知网、维普中文科技期刊和万方数据库，查找并筛选所有需要DR-CPR的VLBWI/ELBWI近远期结局的文献，检索时间自建库至2020年10月26日。对纳入文献进行质量评价，采用 Review Manager 5.3统计软件进行Meta分析，采用Stata 15.0软件进行Egger\'s检验，并绘制漏斗图评估发表偏倚。结果:共纳入16篇回顾性队列研究，均为英文文献，共79 099例VLBWI/ELBWI，需DR-CPR组5 661例，不需DR-CPR组73 438例。Meta分析结果显示，与不需DR-CPR组相比，需DR-CPR组死亡（n RR=2.30，95%n CI 1.89~2.82，n P<0.05n ）、3~4级脑室内出血或脑室周围白质软化（n RR=1.92，95%n CI 1.56~2.36，n P<0.05）、支气管肺发育不良（n RR=1.18，95%n CI 1.04~1.33，n P<0.05）、神经发育损害（n RR=1.25，95%n CI 1.14~1.38，n P<0.05）的发生率增加；两组2期以上早产儿视网膜病发生率（n RR=1.31，95%n CI 0.96~1.79，n P=0.09）差异无统计学意义。对ELBWI进行亚组分析，结果与总体结果一致。n 结论:需要DR-CPR的VLBWI/ELBWI死亡、3/4级脑室内出血或脑室周围白质软化、支气管肺发育不良、神经发育损害的风险更高。“,”Objective:To evaluate the outcomes of cardiopulmonary resuscitation in the delivery room (DR-CPR) at birth for very/extremely low birth weight infants (VLBWI/ELBWI).Method:PubMed, Embase, Cochrane Library, CNKI, VIP database and Wanfang database were searched. The search time limit is from the establishment of the database to October 26, 2020. Search and screen all the literature on the short-term and long-term outcomes of VLBWI/ELBWI who require DR-CPR and conduct quality evaluations. Review Manager 5.3 software was used to perform the Meta analysis. Egger\'s test in Stata Software 15.0 was used to draw a funnel plot and validate publication bias.Result:A total of 16 studies were included, all in English. 5 661 VLBWI/ELBWI received DR-CPR, and 73 438 VLBWI/ELBWI did not receive DR-CPR. The Meta analysis showed: DR-CPR for VLBWI/ELBWI was associated with an increased risk of mortality (n RR=2.30, 95%n CI 1.89~2.82, n P<0.05), grade 3 or 4 intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) (n RR=1.92, 95%n CI 1.56~2.36, n P<0.05),bronchopulmonary dysplasia (BPD) (n RR=1.18,95%n CI 1.04~1.33, n P<0.05), neurodevelopmental impairment (NDI) (n RR=1.25, 95%n CI 1.14~1.38, n Pgrade 2)(n RR=1.31, 95%n CI 0.96~1.79, n P=0.09). The ELBWI was analyzed in subgroups, and the results were consistent with the overall results.n Conclusion:CPR at birth for VLBWI/ELBWI was associated with higher risk of mortality, IVH (grade 3 or 4) or PVL, BPD, NDI.