目的:通过贝叶斯网络荟萃分析比较不同血管扩张剂治疗新生儿持续性肺动脉高压(PPHN)的疗效和安全性。
方法:我们搜索了数据库(Cochrane,PubMed,Embase,和WebofScience)从1月开始,1990年至12月,2023年。使用血管扩张剂治疗PPHN的随机对照试验。我们提取了人口的细节,干预,和结果指标。采用R和STATA软件进行数据分析。包括16篇文章,包括776例新生儿PPHN。其中,对12篇文献进行定量分析。血管扩张剂包括西地那非,波生坦,米力农,镁,腺苷,还有他达拉非.
结果:贝叶斯网络荟萃分析结果表明,与安慰剂相比,米力农[OR=0.125,95%CI(0.0261,0.562)],西地那非[OR=0.144,95%CI(0.0428,0.420)],和西地那非米力农[OR=0.0575,95%CI(0.00736,0.364)]降低了死亡率,但三者之间的差异不显著。低血压的发生率也没有显着差异,机械通气的持续时间,以及在血管扩张剂中使用体外膜氧合。与波生坦相比,腺苷在降低氧合指数方面更有效[MD=-12.78,95%CI(-25.56,-0.03)],镁在降低氧合指数方面的效果低于西地那非[MD=5.19,95%CI(1.23,9.2)]。
结论:米力农,西地那非,和西地那非米力农降低了PPHN新生儿的死亡率。需要更多的临床试验来验证血管扩张剂治疗PPHN的有效性和安全性。
OBJECTIVE: To compare the efficacy and safety of different vasodilators in the treatment of persistent pulmonary hypertension of the newborn (PPHN) by a Bayesian network meta-analysis.
METHODS: We searched databases (Cochrane, PubMed, Embase, and Web of Science) from January, 1990 up to December, 2023. Randomized controlled trials on the use of vasodilators in the treatment of PPHN. We extracted details of population, intervention, and outcome indicators. R and STATA software were used for data analysis. Sixteen articles were included, encompassing 776 neonates with PPHN. Among them, 12 articles were included in the quantitative analysis. The vasodilators included Sildenafil, Bosentan, Milrinone, Magnesium, Adenosine, and Tadalafil.
RESULTS: The Bayesian network meta-analysis results suggested that compared to placebo, Milrinone [OR = 0.125, 95% CI (0.0261, 0.562)], Sildenafil [OR = 0.144, 95% CI (0.0428, 0.420)], and Sildenafil_Milrinone [OR = 0.0575, 95% CI (0.00736, 0.364)] reduced the mortality, but the difference among the three was not significant. There was also no significant difference in the incidence of hypotension, the duration of mechanical ventilation, and the use of extracorporeal membrane oxygenation among the vasodilators. Compared to Bosentan, Adenosine was more effective in reducing the oxygenation index [MD = -12.78, 95% CI (-25.56, -0.03)], and Magnesium was less effective in reducing the oxygenation index than Sildenafil [MD = 5.19, 95% CI (1.23, 9.2)].
CONCLUSIONS: Milrinone, Sildenafil, and Sildenafil_Milrinone reduced the mortality of neonates with PPHN. More clinical trials are needed to verify the efficacy and safety of vasodilators in the treatment of PPHN.