Combined hormonal therapy for the prevention of respiratory distress syndrome and its consequences.
Combined hormonal therapy for the prevention of respiratory distress syndrome and its consequences.
复制标题
用于预防呼吸窘迫综合征及其后果的联合激素疗法。
作者：
F. Moya;I. Gross
在进行这项荟萃分析时，我们尝试使用可比数据，但目前可用的信息存在局限性。一些研究报告了所有输入患者的结果，而其他研究仅报告了接受最佳治疗的患者（表 2）。许多试验尚未以最终形式发表并接受同行评审。此外，这里报道的所有研究都是在表面活性剂疗法广泛使用之前进行的。目前尚不清楚如果同时使用表面活性剂，产前 TRH 和类固醇治疗对死亡或 BPD 等终点的益处是否会持续存在。 （然而，表面活性剂对 BPD 幸存者的百分比影响不大，可能是因为病情较重的婴儿通过这种治疗存活下来并继续发展 BPD。）显然需要对产前 TRH 加类固醇加产后表面活性剂与产前类固醇加产后表面活性剂进行比较的研究，并且世界各地的许多中心正在进行这项研究。由于这些限制，目前不建议常规使用产前 TRH 加类固醇。然而，本文报道的这种疗法在 RDS、死亡和 CLD 方面的明显益处确实表明它可以在选定的情况下使用。一个例子是羊水肺成熟特征不成熟的极早产儿的威胁分娩。即使使用产前类固醇和产后表面活性剂治疗，这些婴儿也有患 RDS 和 CLD 的风险。（摘要截断为 250 字）
In performing this meta-analysis, we have attempted to use comparable data, but there are limitations to the information that is available at present. Some studies reported results for all patients entered, whereas others reported only optimally treated patients (Table 2). Many of the trials have not yet been published in final form and subjected to peer review. In addition, all the studies reported here were conducted before the widespread use of surfactant therapy. It is unclear whether the benefit of antenatal TRH and steroid therapy on end points such as death or BPD would persist if surfactant was also used. (Surfactant has, however, little impact on the percentage of survivors with BPD, perhaps because sicker infants survive with this treatment and go on to develop BPD.) Studies comparing antenatal TRH plus steroid plus postnatal surfactant to antenatal steroid plus postnatal surfactant are clearly required, and are in progress in a number of centers around the world. Because of these limitations, the routine use of antenatal TRH plus steroid cannot be currently recommended. However, the apparent benefits of this therapy in terms of RDS, death, and CLD that have been reported here do suggest that it might be used in selected situations. An example is threatened delivery of a very premature infant with an immature amniotic fluid pulmonary maturation profile. These infants are at risk for RDS and CLD, even if antenatal steroid and postnatal surfactant therapy is used.(ABSTRACT TRUNCATED AT 250 WORDS)