相关实验视频
产前皮质类固醇多次疗程用于早产 (MACS):一种随机对照试验
Kellie E Murphy1, Mary E Hannah, Andrew R Willan
1Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. Canadakmurphy@mtsinai.on.ca
Lancet (London, England)
|December 23, 2008
概括
产前皮质类固醇的多次疗程并不能改善早产的结果. 这种重复治疗与婴儿出生时体重,长度和头部周长的减少有关.
科学领域:
- 产科和妇科 产科和妇科
- 新生儿医学 新生儿医学
- 产周研究 产周研究
背景情况:
- 产前皮质类固醇对于减少早产婴儿呼吸困扰综合征和新生儿死亡至关重要.
- 对于患有长期早产风险的妇女,重复产前皮质类固醇疗程的益处和危害尚未完全理解.
- 以前的研究表明,对呼吸道疾病有潜在的益处,但也存在胎儿生长受损的风险.
研究的目的:
- 评估多次产前皮质类固醇疗程在减少新生儿发病率和死亡率方面的疗效.
- 为了确定重复的产前皮质类固醇给药是否会对胎儿生长产生不利影响.
- 评估14天重复治疗计划的安全性和有效性.
主要方法:
- 一项随机对照试验,涉及1858名怀孕25-32周的妇女,她们有高风险的早产.
- 参与者每14天接受多次产前皮质类固醇疗程或安慰剂,直到第33周或分娩.
- 主要结局是围产/新生儿死亡率和重症新生儿发病率的组合;次要结局包括出生时的人类测量.
主要成果:
- 多重剂量和安慰剂组之间新生儿发病率和死亡率的综合结果没有显著差异 (12.9%对12.5%).
- 与安慰剂组相比,暴露于多次皮质类固醇疗程的婴儿的出生体重 (2216g vs 2330g),长度 (44.5cm vs 45.4cm) 和头周长 (31.1cm vs 31.7cm) 显著降低.
- 观察到的胎儿生长差异具有统计学意义 (p<0.001长度和头周长,p=0.0026体重).
结论:
- 每14天服用多次产前皮质类固醇疗程并不能改善早产的结果.
- 这种重新治疗方案与胎儿生长的显著减少有关,由较低的出生体重,长度和头周长证明.
- 目前的证据不支持使用这种多疗程产前皮质类固醇计划,因为缺乏对胎儿发育的益处和潜在危害.
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