我国示范乡镇卫生院基本药物循证评价与遴选之十:急性胆囊炎  

Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 10.Acute Cholecystitis

作　　者：王应强[1] 李鸿浩[1] 李幼平[1] 李萃萃[1] 杨宗霞[1] 杨晓妍[1] 沈建通[1] 李筱[1] 王莉[1] 李向莲[1] 

机构地区：[1]四川大学华西医院中国循证医学中心,成都610041

出　　处：《中国循证医学杂志》2012年第8期939-947,共9页Chinese Journal of Evidence-based Medicine

基　　金："十一五"国家科技支撑计划重点项目"不同类型乡镇卫生院科技综合示范及相关产品开发"--"乡镇卫生院药物配置与物流关键技术研究与产品开发"课题(编号:2008BAI65B22)

摘　　要：目的基于疾病负担,循证评价与遴选我国示范乡镇卫生院治疗急性胆囊炎的基本药物。方法按本系列研究之二制定的方法、标准和流程,参考国内外循证或权威指南的推荐意见,结合国内相关临床研究及细菌耐药性证据,循证评价并推荐相关药物。主要采用RevMan 5.1、GRADEpro 3.6等软件处理数据、评价证据质量。结果①纳入指南3个(国外2个,国内1个),2个为循证制定,1个为结合专家意见制定;②治疗争性胆囊炎,2个RCT(n=200,低质量)和2个CCT(n=230,低质量)显示,氨苄西林/舒巴坦、哌拉西林/他唑巴坦、环丙沙星和头孢他啶分别联合甲硝唑的有效率为92.5%、92.6%、92.5%和91.3%。3个RCT(n=661,低质量)显示,左氧氟沙星的有效率为82.2%～95.8%,联合甲硝唑的有效率为84.4～94.7%。3个RCT(n=553,低质量)显示,头孢曲松、头孢呋辛和头孢哌酮/舒巴坦的有效率分别为90%、73.7%和95.6%,联合甲硝唑的有效率分别为93.3%,82.5%和92.3%。1个RCT(n=72,低质量)显示,头孢唑啉的有效率为70.9%,细菌耐(G+/G–)药率为70%和87%。结论①强推荐哌拉西林/他唑巴坦、头孢哌酮/舒巴坦治疗轻、中、重度急性胆囊炎;美罗培南、亚胺培南/西司他丁和甲硝唑作为重度急性胆囊炎的备选药物。②弱推荐头孢他啶、头孢吡肟治疗重度急性胆囊炎;头孢替安、氨苄西林/舒巴坦、头孢呋辛治疗轻、中度急性胆囊炎;左氧氟沙星、环丙沙星治疗轻、重度急性胆囊炎;头孢曲松治疗轻、中、重度急性胆囊炎。③不推荐头孢唑啉用于治疗急性胆囊炎。④建议尽量报道大样本对照研究,完善结局指标,以便生产高质量本土化证据。Objective To evaluate and select essential medicine for acute cholecystitis using evidence-based methods based on the burden of disease.Methods By means of the approaches,criteria,and workflow set up in the second article of this series,we referred to the recommendations of evidence-based or authority guidelines from inside and outside China,collected relevant evidence from domestic clinical studies,and recommended essential medicine based on evidence-based evaluation.Data were analyzed by Review Manager（RevMan） 5.1 and GRADE profiler 3.6 to evaluate quality of evidence.Results （1） Three guidelines were included（two foreign guidelines,one domestic guideline;two based on evidence,one based on expert consensus）.（2） Results of two RCTs（n=200,low quality） and two CCTs（n=230,low quality） indicated efficiencies of ampicillin/sulbactam,piperacillin/tazobactam,ciprofloxacin combined with metronidazole,and ceftazidime combined with metronidazole were 92.5%,92.6%,92.5% and 91.3%.A result of three RCTs（n=661,low quality） indicated that lavofloxacin had efficiencies of 82.2% to 95.8% which were 84.4% to 94.7% when combined with metronidazole.A result of three RCTs（n=553,low quality） indicated that for acute cholecystitis,ceftriaxone had an efficiency of 90.0%,cefuroxime 73.7% and cefoperazone/sulbactam 95.6%（Efficiency： ceftriaxone 93.3%,cefuroxime 82.5% and cefoperazone/sulbactam 92.3%,when combined with metronidazole）.A result of one RCT（n=72,low quality） indicated that cephazoline had an efficiency of 70.9% with bacteria resistance rates of 70% for G＋ and 87% for G.Conclusion （1） We offer a strong recommendation for piperacillin/tazobactam and cefoperazone/sulbactam used in the treatment of acute cholecystitis（mild,moderate and severe）.We offer a strong recommendation for meropenem,imipenem/cilastatin and metronidazole as alternatives for severe acute cholecystitis.（2） We offer a weak recommendation for ceftazidime and cefepime used in the treatment of severe acute c

关 键 词：乡镇卫生院 基本药物 循证评价与遴选 急性胆囊炎 

分 类 号：R975[医药卫生—药品]