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口服红霉素防治早产儿喂养不耐受的meta分析

Oral erythromycin for the prevention and treatment of feeding intolerance in preterm infants-meta analysis of randomized controlled trials

摘要:

目的 系统评价口服红霉素防治早产儿喂养不耐受的疗效和安全性.方法 检索Cochrane图书馆、PubMed、EMBASE、中国生物医学文献光盘数据库、中国期刊全文数据库、中国维普数据库和万方全文数据库等刊载的红霉素防治早产儿喂养不耐受的随机对照试验(randomized controlled trial,RCT)文献.按Cochrane系统评价方法进行文献质量评价,采用RevMan软件进行meta分析.对口服红霉索不同剂量(每日3~15 mg/kg为小剂量,>15 mg/kg为大剂量)及纳入对象胎龄(≤32周或>32周)行亚组分析,以评价其在防治早产儿喂养不耐受中的作用.结果 共纳入9个RCT,包括542例早产儿.因部分研究指标存在差异,未能全部行合并分析.(1)预防性研究:对出生胎龄≤32周的早产儿,小剂量较大剂量红霉素口服能缩短达到全肠内喂养及静脉营养时间(WMD=-2.99,95%CI:-3.99~-1.98).(2)治疗性研究:胎龄≤32周时,大剂量红霉素较安慰剂能缩短达到全肠内喂养及静脉营养时间(WMD=-7.06,95%CI:-7.91~-6.20,P<0.01);能缩短住院时间(WMD=-8.10,95%CI:-14.02~-2.18,P=0.007);胎龄>32周时,大剂量红霉素能缩短全肠外营养时间(WMD=-3.90,95%CI:-7.20~-0.60,P<0.05);与对照组相比,红霉素可以降低黄疸发生率(RR=0.36,95%CI:0.21~0.63,P=0.0003),依据剂量大小行亚组分析提示仅大剂量红霉素能减少黄疽的发生.结论 对胎龄≤32周的早产儿,预防性使用小剂量红霉素能缩短达全肠内喂养及静脉营养的时间.而在治疗时,大剂量红霉素能加快达全肠内喂养时间,缩短住院及静脉营养时间,而且还能减少胆汁淤积相关性黄疸的发生.

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abstracts:

Objective To evaluate the efficacy and safety of oral erythromycin in the prevention and treatment of feeding intolerance in preterm infants. Methods The Cochrane Library,PubMed,EMBASE,CBMdise,VIP,WartFang and CNKl were searched up to the year of 2008.Randomized controlled trials (RCT) of erythmmycin for feeding intolerance in preterm infants were included.According to the dosage (low-dose,3-15 mg/kg and high dose,>15 mg/kg)and gestational age(≤32 weeks vs>32 weeks),all infants were divided into several subgroups.Meta-analysis was performed with the Cochrane Collaboration's software RevMan. Results Nine RCrs involving 542 premature infants were included.(1)In preventive studies,low-dose erythromycin could significantly decrease the duration of total parenteral nutrition compared with the high-dose erythmmycin (WMD=-2.99,95%CI:-3.99--1.98).(2)Intreatment studies,highdose erythromycin could significantly decrease the duration of total parenteral nutrition (WMD=-7.06.95%CI:-7.91--6.20,P<0.01)and hospital stay (WMD=-8.10,95%CI:-14.02--2.18,P=0.007)compared with the placebo when gestational age≤32 weeks. Erythromydn could decrease the incidence of iaundice(RR=0.36,95%CI:0.21-0.63,P=0.0003)which might be the effect of bigh-dose erytromycin. Conclusions Compared with placebo,oral erythromycin of different dosage might help to achieve full enteral feeding,shorten the duration of parenteral nutrition and hospital stay,and reduce the associated cholestasis jaundice of preterm infants with different gestational age respectively.

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