目的 系统评价俯卧位通气在新生儿呼吸窘迫综合征中的应用效果.方法 计算机检索PubMed、EM-BASE、Cochrane Library、Web of Science、中国生物医学文献数据库、中国学术期刊全文数据库、万方和维普等国内外数据库中有关俯卧位通气应用于新生儿呼吸窘迫综合征的随机对照试验和随机交叉试验.对所得文献依据纳入与排除标准进行筛查,提取资料,评价文献质量,采用RevMan 5.3软件进行Meta分析.结果 最终共纳入10项研究,7项随机对照试验和3项随机交叉试验,包括500例研究对象.Meta分析结果显示,俯卧位通气组的SaO2[MD =2.41,95％ CI (0.87,3.95),P=0.002]、PaO2 [MD=5.20,95％ CI(3.04,7.36),P＜0.001]、PaO2/FiO2[MD =24.40,95％ CI(8.35,40.44),P=0.003]、气胸发生率[RR=0.10,95％CI(0.01,0.76),P=0.03]、颅内出血发生率[RR =0.41,95％CI(0.20,0.83),P=0.01]和机械通气时间[MD=-23.22,95％CI(-38.30,-8.14),P=0.003]与仰卧位通气组相比,差异具有统计学意义;呼吸机相关性肺炎发生率[RR=0.72,95％CI(0.48,1.09),P=0.12]与仰卧位通气组相比,差异无统计学意义.结论 俯卧位通气能够有效改善呼吸窘迫综合征新生儿的SaO2、PaO2和PaO2/FiO2,缩短机械通气时间,降低气胸和颅内出血的发生风险,而对降低呼吸机相关性肺炎的发生率则无明显作用.由于本研究评价指标间存在异质性,且各评价指标纳入的符合标准的研究也不足.因此,需要更多临床多中心、大样本、高质量的研究进一步评价俯卧位通气应用于新生儿呼吸窘迫综合征的效果.%Objective To systematically evaluate the effects of prone position ventilation on newborn with respiratory distress syndrome.Methods We searched databases including PubMed,EMBASE,Cochrane Library,Web of Science,CBM,CNKI,Wanfang and VIP.We included all randomized controlled trials and randomized crossover trials of neonatal respiratory distress syndrome.Studies were selected according to inclusion and exclusion criteria,extracting data and assessing quality.Then RevMan 5.3 software was used to analyze the data.Results Ten studies included seven randomized controlled trials and three randomized crossover trials,and 500 patients were included.The results of meta-analysis showed that in prone position ventilation group SaO2[MD=2.41,95％CI(0.87,3.95),P=0.002],PaO2[MD=5.20,95％CI(3.04,7.36),P＜0.001],Pa2//FiO2[MD=24.40,95％CI(8.35,40.44),P=0.003],the risk of pneumothorax [RR =0.10,95％ CI (0.01,0.76),P=0.03] and intracranial hemorrhage [RR =0.41,95％ CI (0.20,0.83),P=0.01]and duration of mechanical ventilation [MD=-23.22,95％CI(-38.30,-8.14),P=0.003] compared with supine positiongroup had significantly statistical difference;however there was no significant difference in ventilator-associated pneumonia[RR=0.72,95％CI(0.48,1.09),P=0.12] between two groups.Conclusion Prone position ventilation is effective to improve SaO2,PaO2 and PaO2/FiO2,shorten duration of mechanical ventilation and reduce the risk of pneumothorax and intracranial hemorrhage in newborn with respiratory distress syndrome.While it could not effectively reduce incidence of ventilator-associated pneumonia.Due to the limitations of the quality of studies included,multi-centered randomized controlled trials with large sample size are needed in the future to evaluate the effects of prone position ventilation on neonatal respiratory distress syndrome.
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