重症急性胰腺炎预防性抗菌药物治疗的Meta分析  

Antibiotic Prophylaxis in Severe Acute Pancreatitis: A Systematic Review

作　　者：王燕萍[1] 李德榜[2] 董春禄[2] 武新安[1] 

机构地区：[1]兰州大学第一医院药剂科,兰州730000 [2]兰州大学第一医院普外科,兰州730000

出　　处：《中国循证医学杂志》2012年第4期477-483,共7页Chinese Journal of Evidence-based Medicine

基　　金：中央高校基本科研业务费专项资金(编号:lzujb-ky-2011-100)

摘　　要：目的系统评价重症急性胰腺炎(SAP)预防性应用抗菌药物的疗效及其临床意义,为临床合理使用提供依据。方法计算机检索MEDLINE、EMbase、Cochrane图书馆临床对照试验资料库、CBMdisc和CNKI,检索时间均从建库至2010年8月,收集重症急性胰腺炎预防性使用抗菌药物的随机对照试验(RCT)。对符合纳入标准的临床研究进行资料提取和质量评价后,采用RevMan 5.0软件进行Meta分析。结果最终纳入12个随机对照试验,共777例患者。Meta分析结果显示,与对照组相比,预防性使用抗菌药物组在降低SAP病死率[RR=0.75,95%CI(0.50,1.12)]、减少坏死性胰腺感染[RR=0.82,95%CI(0.63,1.09)]、手术干预[RR=0.97,95%CI(0.74,1.26)]和胰腺外感染[RR=0.73,95%CI(0.48,1.10)]方面均无优势。结论现有临床研究证据显示,SAP患者预防性使用抗菌药物并不能有效降低感染性坏死的发生率、病死率及手术干预率。Objective To systematically assess the efficacy and clinical significance of antibiotic prophylaxis in severe acute pancreatitis（SAP）,so as to provide references for its rational clinical application.Methods For collecting the randomized controlled trials（RCTs） about antibiotic prophylaxis in SAP,a search was conducted in MEDLINE,EMbase,Cochrane Central Register of Controlled Trials,CBM and CNKI from the date of their establishment to August,2010.After the clinical studies meeting the inclusive criteria were extracted and their quality was assessed.Meta-analysis was conduced by using RevMan 5.0 software.Results Twelve RCTs were included with a total of 777 patients.The results of Meta-analysis showed compared with the control group,the antibiotic prophylaxis group was not associated with a statistically signi cant reduction in mortality（RR=0.75,95%CI 0.50 to 1.12）,in the incidence of infected pancreatic necrosis（RR 0.82,95%CI 0.63 to 1.09）,in surgical interventions（RR=0.97,95%CI 0.74 to 1.26）,and in the incidence of nonpancreatic infections（RR=0.73,95%CI 0.48 to 1.10）.Conclusion Antibiotic prophylaxis for SAP does not reduce mortality,infected necrosis,or surgical intervention.

关 键 词：抗菌药物预防性应用 重症急性胰腺炎 META分析 系统评价 随机对照试验 

分 类 号：R576[医药卫生—消化系统]