静脉使用抗菌药物预防呼吸机相关性肺炎的Meta分析

目的系统评价静脉使用抗菌药物预防呼吸机相关性肺炎(VAP)的效果。方法对1990年1月至2017年10月国内外发表的关于静脉使用抗菌药物预防VAP的相关文献进行检索,检索工作由两名研究者独立进行,比对两名检索者的最终检索结果,如果存在检索不一致处,由两人讨论解决。对符合标准的文献采用Revoew Manager 5.2软件进行Meta分析。结果经过筛选后共纳入符合要求的文献3篇,共223例患者,其中病例组(预防性静脉使用抗菌药物)112例,对照组(未预防性静脉使用抗菌药物)111例。Meta分析发现两组间VAP发生率有显著差异(RR=0.43,95%CI:0.27～0.68,P=0.0004),而病死率无显著差异(RR=1.34,95%CI:0.81～2.22,P=0.26)。结论预防性静脉使用抗菌药物可降低机械通气患者VAP发生率,但并不能降低VAP病死率。

Meta-analysis of intravenous use of antibiotics to prevent ventilator-associated pneumonia

Objective To systematically evaluate the effect of intravenous use of antibiotics in the prevention of ventilatorassociated pneumonia(VAP). Methods Literatures published at home and abroad from January 1990 to October 2017 on the prevention of VAP by intravenous use of antibiotics were retrieved, the retrieval work were independently conducted by two researchers, the final retrieval results of the two searchers were compared, and the inconsistencies were discussed and resolved between the two searchers. Revoew Manager 5.2 software was used for Meta-analysis of the standard literatures.Results After screening, there were 3 eligible literatures, 223 patients, 112 cases in case group(prophylactic intravenous use of antibiotics) and 111 cases in control group(no prophylactic intravenous use of antibiotics). Meta-analysis showed that the incidence of VAP was significantly different between the two groups(RR=0.43, 95% CI: 0.27-0.68, P=0.0004), but there was no significant difference in mortality(RR=1.34, 95% CI: 0.81-2.22, P=0.26). Conclusion Prophylactic intravenous use of antibiotics can decrease the incidence of VAP in mechanical ventilation patients, but can not reduce the mortality of VAP.