集束化循证感控实践策略对结直肠癌患者手术部位感染预防效果的Meta分析  

Cluster evidence-based infection control care bundles to prevent risk of surgical site infections in patients undergoing colorectal surgery:a meta-analysis

作　　者：杨春艳[1] 古艳云[1] 王雪雁 乔广国 吴敏[1] 张海娇[1] 张诤 YANG Chun-yan;GU Yan-yun;WANG Xue-yan;QIAO Guang-guo;WU Min;ZHAGN Hai-jiao;ZHANG Zheng(Liaocheng People 's Hospital, Liaocheng , Shandong 252000 , China)

机构地区：[1]聊城市人民医院感染管理科,山东聊城252000

出　　处：《中华医院感染学杂志》2019年第8期1194-1200,共7页Chinese Journal of Nosocomiology

摘　　要：目的系统评价集束化循证感控实践策略对结直肠癌患者手术部位感染(Surgical site infection,SSI)的预防效果。方法计算机检索PubMed、Embase、CINAHL、Scopus、Ovid、Cochrane Library、中国学术期刊网络出版总库(CNKI)、万方数据库、维普数据库(VIP)及中国生物医学文献数据库(CBM)(建库到2018年6月)中关于循证感控实践策略用于预防结直肠癌患者SSI的随机对照实验和临床对照实验。经文献检索、文献筛选、数据提取与质量评价后,采用RevMan 5.3软件进行Meta分析、亚组分析。结果最终纳入14篇文献,8 562例患者。其中3篇随机对照实验(randomized controlled trail,RCT),11篇临床对照实验(Controlled clinical trail,CCT)。经Meta分析,与单项措施相比,集束化循证感控策略可有效预防结直肠癌患者手术部位切口感染率,差异具有统计学意义(RR=0.56,95%CI:0.39-0.82;P=0.002);在表浅切口感染、深部切口感染方面,集束化循证感控策略与单项措施的差异无统计学意义;在器官腔隙感染方面,集束化循证感控实践策略与单项措施的感染率差异有统计学意义(RR=0.58,95%CI:0.35-0.95;P=0.03);亚组分析显示,研究类型有可能是异质性来源,研究类型亚组间比较有统计学差异(χ2=7.15,P=0.007);诊断标准亚组间比较无统计学差异(χ2=1.14,P=0.29)。结论当前证据显示,集束化循证感控实践策略可有效改善结直肠癌患者SSI发生率和器官腔隙感染率,但针对集束捆绑方式,建议进一步开展科学性研究进行深入探讨。OBJECTIVE To systematically review the effectiveness of evidence-based infection control care bundles to reduce surgical site infection (SSI) among patients undergoing colorectal surgery. METHODS The literature about the impact of evidence-based infection control care bundles to reduce surgical site infection was retrieved from digital databases of PubMed, Embase, CINAHL, Scopus, Ovid, The Cochrane library, CNKI, VIP, CBM and WanFang data(from establishment to Jun. 2018). The literature contained randomized controlled trials (RCTs) and clinical control studies (CCTs). The Meta-analysis and subgroup analysis were performed after searching and screening databases, extracting data and assessing the quality of included studies using RevMan 5.3. RESULTS Fourteen published studies with 8562 patients were included for Meta-analysis, which contained 3 RCTs and 11 CCTs.The Meta-analysis results showed that, compared with single measures, the evidence-based infection control care bundles could effectively prevent the risk of surgical site infections in patients undergoing colorectal surgery, and the difference was significant [RR =0.55,95%CI :0.39-0.77;P =0.002]. In superficial infection and deep infection, there was no significant difference between infection control care bundles and single measures. However,in organ space infection, there was significant difference in infection rate between infection control care bundles and single measures (RR = 0.58,95%CI : 0.35-0.95;P = 0.03). Subgroup analysis showed that research types may be a source of heterogenity.There were significant differences between the types of subgroups (X^2 =7.15 ,P = 0.007). There was no significant difference between the diagnostic criteria subgroups (X^2= 1.14,P = 0.29). CONCLUSION The systematic review and Meta-analysis documents showed that use of an evidence-based surgical care bundles in patients undergoing colorectal surgery significantly reduced the incidence of SSI and the infection rate of organ lacuna. However, in view of the bundling mode,

关 键 词：集束化 结直肠癌患者 手术部位感染 META分析 

分 类 号：R619.3[医药卫生—外科学]