目的 系統(tǒng)評價布地奈德不同給藥方式聯(lián)用肺表面活性劑治療新生兒呼吸窘迫綜合征（neonatal respiratory distresssyndrome，NRDS）的臨床療效和安全性。方法 計算機檢索中國學術期刊全文數(shù)據(jù)庫（CNKI）、萬方數(shù)據(jù)知識服務平臺（Wanfang Data）、維普期刊中文數(shù)據(jù)庫（VIP）、中國生物醫(yī)學文獻數(shù)據(jù)庫（CBM）、PubMed、EMBase、the CochranceLibrary數(shù)據(jù)庫，收集從建庫至2021年2月發(fā)表的布地奈德持續(xù)吸入、單劑吸入和氣管滴入分別聯(lián)用肺表面活性劑治療NRDS的臨床對照研究。提取符合納入標準的文獻并進行質(zhì)量評價，運用RevMan 5.3軟件進行Meta分析。結果 共納入10篇文獻，1 049例患者，持續(xù)吸入組400例，單劑吸入組265例，氣管滴入組384例。Meta分析結果顯示：布地奈德持續(xù)吸入組治療后氧合指數(shù)增加值大于氣管滴入組和單劑吸入組，中重度支氣管肺發(fā)育不良（BPD）發(fā)生率、輔助通氣時間、有創(chuàng)機械通氣率和肺表面活性劑反復使用率小于氣管滴入組和單劑吸入組；氣管滴入組治療后增加值大于單劑吸入組，中重度BPD發(fā)生率、輔助通氣時間、有創(chuàng)機械通氣率和肺表面活性劑反復使用率小于單劑吸入組，差異均有統(tǒng)計學意義（P<0.05）。結論 布地奈德不同用藥方式聯(lián)用肺表面活性劑治療NRDS的臨床療效存在一定差異，持續(xù)霧化吸入給藥是最優(yōu)用藥方案，其次為氣管滴入給藥，再次為單劑霧化吸入。

Objective To systematically evaluate the the efficacy of different administration of budesonide combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods The CNKI, Wanfang database, VIP database, CBM, PubMed, EMBase, The Cochrance Library were retrieved to collect the randomized controlled trials of budesonide continuous inhalation, single inhalation and tracheal instillation combined with Surfactant in the treatment of NRDS. According to inclusion and exclusion criteria, qualified literature was screened for evaluation, data was extracted and Meta-analysis was performed with RevMan 5.3 software. Results A total of 10 related studies were collected, including 1 049 children, and 400 cases in continuous inhalation group, 265 cases in single inhalation group and 384 cases in tracheal instillation group.The results of Meta-analysis showed that the increase of oxygenation index (OI) in the continuous inhalation group was highest than that in the tracheal instillation group and the single inhalation group, the incidence of moderate and severe BPD, the time of auxiliary ventilation, the rate of invasive mechanical ventilation and the rate of repeated use of PS were lowest than those in the tracheal instillation group and the single inhalation group, and the increase of OI in the tracheal instillation group was higher than that in the single inhalation group, the incidence of moderate and severe BPD, the time of auxiliary ventilation, the rate of invasive mechanical ventilation and the rate of repeated use of PS were lower than those in the single inhalation group, all the differences were statistically significant (P < 0.05). Conclusion The clinical effect of different administration of budesonide combined with PS in the treatment of NRDS are different, continuous inhalation group of budesonide combined with PS is the best scheme, the second is tracheal instillation, and the third is single inhalation.

R974

湖北省衛(wèi)健委科研項目（WJ2019H485）