术前预防性应用抗生素对经皮肾镜碎石术后感染预防效果的Meta分析  

Preventive effect of preoperative preventive antibiotics on infection after percutaneous nephrolithotomy:a Meta-analysis

作　　者：郭宝玉 於江泉[2] 吴银霞[2] 陈天 郭哲[1,2] 石群 邓泽勋 彭鑫鑫 俞俊杰 Guo Baoyu;Yu Jiangquan;Wu Yinxia;Chen Tian;Guo Zhe;Shi Qun;Deng Zexun;Peng Xinxin;Yu Junjie(Dalian Medical University,Dalian 116044,China;Department of Urology,Northern Jiangsu Peoples Hospital,Yangzhou 225001,China;Department of Urology,Meihekou Central Hospital,Tonghua 135000,China)

机构地区：[1]大连医科大学,大连116044 [2]江苏省苏北人民医院泌尿外科,扬州225001 [3]吉林省梅河口市中心医院泌尿外科,通化135000

出　　处：《国际泌尿系统杂志》2021年第4期635-639,共5页International Journal of Urology and Nephrology

基　　金：国家自然科学基金项目(81572702、81402101)。

摘　　要：目的探讨术前预防性应用抗生素对经皮肾镜碎石术(PCNL)后感染的有效性方法制定原始文献的纳人标准、排除标准及检索策略,使用PubMed、Embase和中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)进行系统的文献检索,以找到术前不同抗生素预防策略在PCNL中预防术后感染的效果的比较研究进行相关的文献的检索、评价和资料提取:结果本研究共纳人6篇文章,848例患者,Meta分析显示:与麻醉前单剂量组相比,术前预防性应用抗生素的患者(预防组)术后脓毒症(OR=0.31,95%CI:0.20~0.50,P<0.001)、发热(OR=0.29,95%CI:0.15-0.57,P<0.001)发生率较低;并且预防组显著降低了术后肾盂尿培养阳性率(0R=0.21,95%CI:0.07~0.57,P=0.002)和肾结石培养阳性率(OR=0.31,95%CI:0.18~0.54,P<0.001)。结论对于尿培养阴性的患者术前应用抗生素对预防PCNl术后感染是有效的,它降低了术后脓毒症和发热的风险,并且显著降低了肾结石和肾盂尿培养阳性率,因此建议对尿培养阴性患者常规预防性应用抗生素,但是预防的具体时间需要更大样本量和更严格的随机对照试验来验证。Objective To explore the efficacy of antibiotic prophylaxis in perioperative period of percutaneous nephrolithotomy(PC ML)by conducting a systematic review and Meta-analysis.Methods A systematic literature search using PubMed,Embase and the Chinese SinoMed,CNKI,Wan-Fang and VIP databases was performed to find comparative studies on the efficacy of different antibiotic prophylaxis strategies in PCNL for preventing postoperative sepsis.Results Six independent studies comprising up to 848 individuals were included.Compared with single dose before anesthesia,preoper-ative prophylactic antibiotics significantly reduced postoperative sepsis(OR=0.31,95%CI:0.20-0.50,P<0.001)and fever(OR=0.29,95%CI:0.15-0.57,P<0.001).Compared with single dose before anesthesia,preoperative prophylactic antibiotics significantly reduced positive pelvic urine(OR=0.21,95%CI:0.07-0.57,P=0.002)and stone cultures(OR=0.31,95%CI:0.18-0.54,P=0.001).Conclusions Preoperative prophylactic antibiotics indeed reduces the risk of postoperative sepsis and fever.Besides,preoperative prophylactic antibiotics reduces positive pelvic urine and stone cultures significantly.

关 键 词：肾造口术 经皮 抗生素 感染 

分 类 号：R699[医药卫生—泌尿科学]