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血清乳酸和新生儿的发病率和死亡率之间的关联:系统性审查和元分析
Felipe Yu Matsushita1,2, Vera Lucia Jornada Krebs1,2, Werther Brunow De Carvalho1,2
1Department of Pediatrics, Neonatology Division, Faculty of Medicine, University of São Paulo, São Paulo 01246-903, Brazil.
Children (Basel, Switzerland)
|November 25, 2023
概括
新生儿乳酸盐水平较高与死亡率和发病率风险增加有关. 然而,对于查新生儿的不良结果,不建议单独使用乳酸,序列测量更有价值.
科学领域:
- 新生儿重症监护的新生儿重症监护
- 在儿科中的生物标志物.
- 围产期研究 围产期研究
背景情况:
- 乳酸盐是严重病情严重的成年人中低 perfusion 的公认指标.
- 乳酸对新生儿风险分层的有用性与不良结果尚未得到充分确立.
研究的目的:
- 调查新生儿血液中乳酸盐水平与不良结果 (包括发病率和死亡率) 之间的联系.
- 评估乳酸盐作为查工具的潜力,用于识别高风险新生儿.
主要方法:
- 这是一项对63项涉及46,069名新生儿的观察性和数据准确性研究的综合元分析.
- 在主要数据库 (Ovid MEDLINE,EMBASE,Cochrane Library,ClinicalTrials.gov) 进行系统的文献搜索.
- 使用纽卡斯尔-太华尺度和QUADAS-2工具进行偏差风险评估.
主要成果:
- 乳酸盐水平升高与新生儿死亡率增加显著相关 (SMD-1.09).
- 单独的乳酸盐测试显示了中度的准确性,在预测结果中可能出现显著的虚假阴性 (3.46%) 和虚假阳性 (17.76%).
- 该研究分析了主要结果 (死亡率) 和二次结果,如急性损伤,神经问题和呼吸道疾病.
结论:
- 新生儿乳酸水平较高与死亡率和各种疾病风险更高有关.
- 仅仅测量乳酸是不足以可靠地查新生儿的不良结果.
- 未来的研究应该优先考虑在单个时间点上分析连续乳酸盐测量,以提高临床效用.
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