미숙아 무호흡을 위한 비강 지속적 양압환기법 효과에 대한 체계적 고찰
Systematic Review of Effects of Nasal Continuous Positive Airway Pressure on Apnea of Preterm Infants
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목적 본 연구는 국내외 연구의 체계적 문헌고찰을 통해 미숙아무호흡에대한 nCPAP의 효과를 재확인하고 nIPPV 중 nSIPPV를 적용한 연구들을 구별하여 효과 차이가 있는지 확인해보고자 한다. 본 연구의 결과를 토대로 고위험신생아 간호전략을 위한 기초적인 자료를 제공하기 위해서이다. 방법 본 연구에서는 1970년 1월부터 2013년 9월까지 미숙아 무호흡증을대상으로 nCPAP를 제공하고 그 효과를 확인한 연구를 대상으로 검색하였다. 영문 검색어는 ‘preterm infant’, ‘prematurity’, ‘nCPAP’, ‘apnea’,‘trial’ 이었으며 국문검색어는 ‘미숙아’, ‘무호흡’, ‘무호흡중재’로 검색하였다. 총 13편의 논문분석을 위하여 코딩의 준거분석틀에 따라 자료코딩을 하였다. 자료의 코딩에 따른 준거분석틀은 다음과 같다. 먼저 각 연구 특성에 따른 자료의 코딩은 연구자, 게재연도, 표본크기, 중재방법, 중재시간, 주요결과, 적용시간, 실험설계의 편향 유형을 조사하여 제시하였다. 코딩된 자료는 신뢰구간 95%, 통계적 유의수준 5%로 정하며이용된 프로그램은 STATA 10.0을 이용하였다. 결과 nCPAP의 무호흡감소의 효과와 nIPPV의 차이는 -0.11 (95% CI [-0.64,0.42])로 유의한 차이가 검증되지 않았다(Z = 0.41, p =.680). 그러나nCPAP와 nSIPPV의 효과차이는 결합추정치 -0.44 (95% CI [-0.81,-0.07)로 nSIPPV가 미숙아무호흡 감소에 효과가 있는 것으로 나타났다(Z =2.35, p =.019). nCPAP의 호흡기치료중지 성공에 대한 효과를 메타분석 한 결과 1.60 (95% CI [0.70, 3.63])이었으며 nIPPV와 차이가 검증되지 않았다(Z =1.12, p =.268). 그러나 nSIPPV는 nCPAP에 비해 결합추정치는 3.94 (95% CI [1.74, 8.90])로 호흡기치료 중지에 효과가 있는것으로 나타났다(Z=3.29, p =.0001). 결론 미숙아의 무호흡감소와 호흡기치료의 단축을 위해 nCPAP와 nIPPV중 nSIPPV의 효과를 확인하였으며 본 연구결과를 기초로 임상에서 활용 가능한 미숙아 호흡관리 프로토콜 개발을 위해 지속적인 연구들이 진행되어져야 할 것이다.
Abstract
Purpose: The purpose of this study was to analysis the effects of nasal Continuous Postive Airway Pressure (nCPAP) for preterm infants usingsystematic review and meta-analysis. Methods: Thirteen peer-reviewed journals including preterm infants and apnea and nCPAP publishedbetween 1973 and 2013 were included. Effect size and statistics of homogeneity were done using STATA 10.0. Results: The design for 9 studieswas Randomized Control Trial. In most of studies the pressure of nCPAP was set to 4-6 cmH2O. The effect size of 5 studies for the effect onapnea rate using nCPAP compared to nasal Intermittent Positive Pressure Ventilator (nIPPV) showed that the Standardized Mean Difference(SMD) was -0.11 and was not significantly different (Z=0.41, p=.680). But the difference in nCPAP for nasal Synchronizes Intermittent PositivePressure Ventilator (nSIPPV) (subgroup) was significant (SMD=-.44). The effect size of 7 studies on effect for ventilator weaning of usingnCPAP compared to nIPPV showed the Risk Ratio (RR) as 1.60 and was not significantly different (Z=1.12, p=.268). But the differencebetween nCPAP and nSIPPV (subgroup) was significant (RR=3.94). Conclusion: The results indicate a need for an advanced care system andsuggest continuous studies of apnea in preterm infants.
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