不同抗菌药物疗程对呼吸机相关性肺炎患者疗效影响的Meta分析  

Influence of Different Courses of Antibiotics on Efficacy of Ventilator Associated Pneumonia:a Meta-analysis

作　　者：马红叶 郭利涛[1] 孙婧婧 张蕾[1] 王天罡 刘红娟[1] MA Hongye;GUO Litao;SUN Jingjing;ZHANG Lei;WANG Tiangang;LIU Hongjuan(Department of Critical Care Medicine,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Network Information,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院重症医学科,陕西省西安市710061 [2]西安交通大学第一附属医院信息中心,陕西省西安市710061

出　　处：《实用心脑肺血管病杂志》2021年第5期75-79,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家临床重点专科项目(2011-872);西安交通大学第一附属医院基金项目(2019ZYTS-12)。

摘　　要：背景机械通气可能导致呼吸机相关性肺炎(VAP),抗感染治疗是其主要治疗措施。近年随着细菌耐药形势愈发严峻,合理应用抗菌药物尤为重要。目的探讨不同抗菌药物疗程对VAP患者疗效的影响,以期为临床优化抗菌药物、减少耐药菌提供参考。方法计算机检索中国知网(CNKI)、万方数据知识服务平台、中国生物医学文献数据库(CBM)及PubMed、Embase、Cochrane Library等数据库,检索时间为1995—2020年。短疗程组为VAP患者抗菌药物疗程<10 d;长疗程组为VAP患者抗菌药物疗程≥10 d。比较两组患者病死率、VAP复发率、机械通气时间、ICU住院时间。采用Review Manager 5.2软件进行Meta分析。结果最终纳入5篇文献,包含943例患者,其中短疗程组466例,长疗程组477例。Meta分析结果显示,两组患者病死率〔相对危险度(RR)=1.11,95%CI(0.87,1.43)〕、机械通气时间〔均数差(MD)=0.26,95%CI(-0.40,0.92)〕、ICU住院时间〔MD=-0.61,95%CI(-1.91,0.70)〕比较,差异无统计学意义(P>0.05)。长疗程组患者VAP复发率低于短疗程组〔RR=1.34,95%CI(1.05,1.73),P=0.02〕。结论与抗菌药物疗程≥10 d相比,抗菌药物疗程<10 d同样可达到有效治疗VAP的目的,但抗菌药物疗程<10 d者VAP复发率较高。Background Mechanical ventilation may lead to ventilator-associated pneumonia(VAP),and antiinfection therapy is the main treatment on VAP.The problem of bacterial resistance is getting worse.Using antibiotic rationally is particularly important.Objective To investigate the influence of different courses of antibiotics on the efficacy of VAP patients,in order to provide evidence for clinical optimization of antibiotics using and the reduction of drug-resistant bacteria.Methods Trials(1995—2020)from China National Knowledge Network(CNKI),Wanfang Data,China Biomedical Literature Database(CBM),PubMed,Embase,Cochrane Library and the other databases were searched.VAP patients treated with antibiotics for less than 10 days were included in the short term group,VAP patients treated with antibiotics for 10 days or more than 10 days were selected as the long term group.The mortality rate,recurrence rate of VAP,duration of mechanical ventilation and ICU hospitalization time were compared between the two groups.Review Manager 5.2 software was used for meta-analysis.Results Finally,5 literatures were included,with 943 cases of patients involved,including 466 patients in short term group and 477 patients in long term group.The results of meta-analysis showed that,there was no significant inter-group difference in mortality rate〔RR=1.11,95%CI(0.87,1.43)〕,duration of mechanical ventilation〔MD=0.26,95%CI(-0.40,0.92)〕and ICU hospitalization time〔MD=-0.61,95%CI(-1.91,0.70)〕(P>0.05,for all).The VAP recurrence rate of the long term group was lower than that of the short term group〔RR=1.34,95%CI(1.05,1.73),P=0.02〕.Conclusion Compared with the patients using antibiotics for 10 days or more than 10 days,the patients using of antibiotics for less than 10 days can also treat VAP effectively.However,the recurrence rate of VAP increased in patients using of antibiotics for less than 10 days.

关 键 词：肺炎 呼吸机相关性 抗生素 疗程 META分析 

分 类 号：R639[医药卫生—外科学]