抗菌药物预防人工流产术后感染效果的系统性评价  

Evaluation of the effectiveness of antimicrobials in infection prevention after induced abortion surgery:a systematic review and meta-analysis

作　　者：冉江玲 张家兴[2] 赵华叶 张瑞 胡鳞方 王家雪 蓝俊杰 孙水梅 谭松松 曹金永 李小让 RAN Jiang-ling;ZHANG Jia-xing;ZHAO Hua-ye;ZHANG Rui;HU Lin-fang;WANG Jia-xue;LAN Jun-jie;SUN Shui-mei;TAN Song-song;CAO Jin-yong;LI Xiao-rang(College of Pharmacy,Guizhou University of Traditional Chinese Medicine,Guiyang 550002;Department of Pharmacy,Guizhou Provincial People’s Hospital,Guiyang 550002;Department of Medical Insurance,Guizhou Provincial People’s Hospital,Guiyang 550002;Department of Endoscopy,Guizhou Provincial People’s Hospital,Guiyang 550002)

机构地区：[1]贵州中医药大学药学院,贵阳550002 [2]贵州省人民医院药剂科,贵阳550002 [3]贵州省人民医院医保处,贵阳550002 [4]贵州省人民医院内镜科,贵阳550002

出　　处：《中南药学》2024年第1期219-226,共8页Central South Pharmacy

基　　金：国家自然科学基金项目(No.72064004);贵州省中医药民族医药科学技术项目(No.QZYY-2023-042);贵州省卫生健康委科学技术基金项目(No.gzwkj2022-224,No.gzwkj2021-553)。

摘　　要：目的 系统评价抗菌药物预防人工流产术后感染的效果。方法 通过计算机检索PubMed、Cochrane Library、Embase、CNKI、万方、维普数据库,纳入关于评价抗菌药物预防人工流产术后感染的随机对照试验,检索时限均为建库至2023年8月28日,由两名研究者根据纳入与排除标准独立进行文献筛选、数据提取和质量评价,采用Rev Man 5.4软件进行meta分析。结果 共纳入12项研究,合计5364例患者。meta分析结果显示,与使用安慰剂相比,无高危因素的人工流产手术患者术前使用抗菌药物术后子宫内膜炎的发生率相当(RR=0.35,95%CI:0.11~1.08,P=0.07)、输卵管炎发生率相当(RR=0.79,95%CI:0.08~7.49,P=0.83);阴道菌群异常的人工流产手术患者术前使用抗菌药物术后盆腔感染风险降低(RR=0.40,95%CI:0.23~0.67,P=0.0006);患有盆腔炎病史的人工流产手术患者术前使用抗菌药物术后盆腔感染风险降低(RR=0.61,95%CI:0.41~0.89,P=0.01);没有盆腔炎病史的人工流产手术患者术前使用抗菌药物术后盆腔感染风险相当(RR=0.75,95%CI:0.55~1.02,P=0.07)、膀胱炎发生率相当(RR=0.50,95%CI:0.09~2.70,P=0.42);衣原体阴性或阳性的人工流产手术患者术前使用抗菌药物术后盆腔感染风险相当(RR=0.59,95%CI:0.28~1.23,P=0.16;RR=0.36,95%CI:0.06~2.24,P=0.27)。结论 当前证据显示,术前给予抗菌药物仅对阴道菌群异常和患有盆腔炎病史的人工流产手术患者是有获益的,但该结论还有待高质量的原始研究进一步验证。Objective To systematically evaluate the effectiveness of antimicrobials infection prevention after induced abortion surgery.Methods PubMed,Cochrane Library,Embase,CNKI,Wanfang and VIP were searched for randomized controlled trials on the effectiveness of antimicrobials in infection prevention after induced abortion surgery.Data from the establishment of the database to August 28,2023 were searched.Two researchers independently screened the literature,collected data,and assessed their quality according to the established inclusion and exclusion criteria.Rev Man 5.4was used for the meta-analysis.Results Totally 12 studies(involving 5364 patients) were included.The meta-analysis showed that compared with the placebo,abortion patients without high-risk factors,antimicrobials did not reduce the risk of postoperative endometritis(RR = 0.35,95%CI:0.11 ~ 1.08,P = 0.07) and salpingitis infection(RR = 0.79,95%CI:0.08 ~ 7.49,P = 0.83);For abortion patients with abnormal vaginal flora,reduced the risk of postoperative pelvic infection(RR = 0.40,95%CI:0.23 ~ 0.67,P = 0.0006);For abortion patients with a history of pelvic inflammation,antimicrobials reduced the risk of postoperative pelvic infection(RR = 0.61,95%CI:0.41 ~ 0.89,P = 0.01);For abortion patients without a history of pelvic inflammation antimicrobials did not reduce the risk of postoperative pelvic infection(RR = 0.75,95%CI:0.55 ~ 1.02,P = 0.07) and cystitis infection(RR = 0.50,95%CI:0.09 ~ 2.70,P = 0.42);For abortion patients with chlamydia-negative/-positive,antimicrobials did not reduce the risk of postoperative pelvic infection(RR = 0.59,95%CI:0.28 ~ 1.23,P = 0.16;RR = 0.36,95%CI:0.06 ~ 2.24,P = 0.27).Conclusion Current evidence suggests that antibiotic prophylaxis can be beneficial for abortion patients with abnormal vaginal flora or with a history of pelvic inflammation,but this conclusion should be verified with high quality primary studies.

关 键 词：人工流产术 抗菌药物 预防 感染 系统评价 META分析 

分 类 号：R169.42[医药卫生—公共卫生与预防医学]