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中华产科急救电子杂志 ›› 2022, Vol. 11 ›› Issue (04) : 222 -227. doi: 10.3877/cma.j.issn.2095-3259.2022.04.007

所属专题: 指南共识

指南·标准·共识

2022年RCOG《产前糖皮质激素降低新生儿发病率和死亡率》指南要点解读
周术卫1, 王岚1, 漆洪波1,()   
  1. 1. 401147 重庆市妇幼保健院 重庆医科大学附属妇女儿童医院妇产科
  • 收稿日期:2022-04-06 出版日期:2022-11-18
  • 通信作者: 漆洪波
  • 基金资助:
    四川省区域创新合作项目(2020YFQ0006)

Interpretation of Royal College of Obstetricians and Gynaecologists guideline (2022) "antenatal corticosteroids to reduce neonatal morbidity and mortality"

Shuwei Zhou1, Lan Wang1, Hongbo Qi1()   

  • Received:2022-04-06 Published:2022-11-18
  • Corresponding author: Hongbo Qi
引用本文:

周术卫, 王岚, 漆洪波. 2022年RCOG《产前糖皮质激素降低新生儿发病率和死亡率》指南要点解读[J]. 中华产科急救电子杂志, 2022, 11(04): 222-227.

Shuwei Zhou, Lan Wang, Hongbo Qi. Interpretation of Royal College of Obstetricians and Gynaecologists guideline (2022) "antenatal corticosteroids to reduce neonatal morbidity and mortality"[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2022, 11(04): 222-227.

预计早产前给予孕妇糖皮质激素是改善新生儿结局重要的干预措施之一,能有效降低新生儿呼吸系统发病率和其他早产并发症[1]。2022年2月英国皇家妇产科医师学会(Royal College of Obstetricians and Gynaecologists,RCOG)发布了《产前糖皮质激素降低新生儿发病率和死亡率》指南[2],替代2010年第1版指南,从而为产前糖皮质激素(antenatal corticosteroids,ACS)的规范使用提供了最新的循证建议。

表1 使用ACS的风险和益处[2]
使用时间 获益 危害 不确定性
22~34+6 极有可能减少:
·围产儿死亡
NNT 43.5(95%CI:27.8-100.0)
·新生儿死亡
NNT 38.5(95%CI:27.8-62.5)
·新生儿呼吸窘迫
NNT 23.3(95%CI:19.2-30.3)
可能减少:
·IVH
NNT 71.4(95%CI:55.6-125.0)
·儿童发育迟缓
NNT 27(95%CI:17.9-500.0)
如果分娩是在开始治疗后24-48 h内,上述情况最有可能减少
如果在开始治疗后7 d内分娩,可能会降低呼吸系统疾病的发病率
·给药后可能影响母体葡萄糖耐量长达5 d(糖尿病女性风险更高)
·如果在给药后7 d以上分娩,可能会降低出生体重
·如果在开始治疗后超过7 d分娩,可能不会有任何好处
·针对多胎妊娠的证据较少
·较少研究报道不必要的ACS(在使用后7 d以上分娩)的影响
·虽然尚未证明有长期危害,但缺乏药物安全所需的大规模观察性研究
35~36+6 可能减少:
·呼吸支持
NNT 33.3(95%CI:21.5-76.9)
·可能增加新生儿低血糖
NNH 11.1(95%CI:8.8-14.7)
·如果足月分娩,可能增加精神和行为障碍
NNH 38.8(95%CI:30.5-52.4)
·虽然尚未证明有长期危害,但缺乏药物安全所需的大规模观察性研究
·如果在开始治疗后超过7 d分娩,似乎不太可能产生益处,但尚未在该孕周的孕妇中进行研究
37~38+6周计划性剖宫产前 可能减少:
·因呼吸系统疾病入住新生儿病房
NNT 35.7(95%CI:25.1-196.1)
·可能会降低学龄儿童的学习成绩 ·目前尚不确定NRDS、湿肺或总体入住新生儿病房是否有所减少
·低血糖等短期并发症尚未经过严格研究,但可能和晚期早产一样也适用于此孕周
·如果在开始治疗后超过7 d分娩,似乎不太可能产生益处,但尚未在此孕周的孕妇中进行研究
·虽然尚未证明有长期危害,但缺乏药物安全所需的大规模观察性研究
若ACS治疗超过7 d仍有早产风险给予挽救疗程 可能减少:
·对呼吸支持的需求
NNT 11.9(95%CI:9.9-14.9)
·可能降低出生体重、头围、身长以及新生儿血压 ·危害与剂量相关
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