抗菌药物的降阶梯策略治疗呼吸机相关性肺炎的Meta分析(1)
[摘要] 目的 評价抗菌药物降阶梯策略对呼吸机相关性肺炎(VAP)的效果，以优化VAP抗感染治疗方案，改善预后。 方法 计算机检索PubMed、Cochrane library、EMBASE、CBM、CNKI、万方数据库1995年1月～2017年12月国内外发表的相关文献，以呼吸机相关性肺炎、抗菌药物、抗生素、目标治疗、降阶梯作为检索词，对符合纳入标准的文献借助Review Manager 5.2软件进行Meta分析，评价降阶梯治疗对VAP复发率、机械通气时间、初始治疗合理率、重症加强护理病房(ICU)住院时间及病死率的影响。 结果 共纳入文献6篇，纳入1293例患者，其中降阶梯组831例，对照组462例。降阶梯组VAP复发率显著低于对照组(RR = 0.52，95%CI：0.34，0.80)，机械通气时间短于对照组(RR = -7.30，95%CI：-10.97，-3.64)，差异均有高度统计学意义(均P < 0.01)。两组VAP初始治疗合理率、ICU住院时间、病死率比较，差异无统计学意义(P > 0.05)。 结论 降阶梯治疗策略可有效降低患者VAP复发率，缩短机械通气时间。
[关键词] 呼吸机相关性肺炎;抗菌药物;降阶梯;Meta分析
[中图分类号] R563.1 [文献标识码] A [文章编号] 1673-7210(2019)12(b)-0107-06
[Abstract] Objective To systematically evaluate the effect of de-escalation treatment of antibiotic strategy on the patient with ventilator-associated pneumonia (VAP)， so as to optimize VAP anti-infective treatment programs and improve prognosis. Methods The relevant literatures published in China and abroad from January 1995 to December 2017 were retrieved from the databases including PubMed， Cochrane library， EMBASE， CBM， CNKI， and Wangfang database by computer. The key words were ventilator-associated pneumonia， antibacterial drugs， antibiotics， target treatment and de-escalation. The Meta-analysis was performed for the eligible literatures with the Review Manager 5.2 software. The effect of step-down treatment on VAP recurrence rate， mechanical ventilation duration， initial treatment reasonable rate， intensive care unit (ICU) hospitalization time and mortality were evaluated. Results A total of 6 articles were included in the study， with 1293 patients involved， including the de-escalation group with 831 cases and the control group with 462 cases. The relapse rate of VAP in de-escalation group was lower than that in control group (RR = 0.52， 95%CI： 0.34， 0.80)， while the mechanical ventilation duration of de-escalation group was shorter than that in control group (RR = -7.30， 95%CI： -10.97， -3.64)， and the differences were all highly statistically significant (all P < 0.01). However， there were no significant differences in the initial treatment reasonable rate of VAP， ICU hospitalization time， and mortality between the two groups (P > 0.05). Conclusion The de-escalation of antibiotic therapy can decrease the relapse rate of VAP and reduce the mechanical ventilation duration effectively.
[Key words] Ventilator-associated pneumonia; Antibiotic; De-escalation treatment; Meta-analysis, 百拇医药(孙婧婧 郭利涛 马红叶)
[关键词] 呼吸机相关性肺炎;抗菌药物;降阶梯;Meta分析
[中图分类号] R563.1 [文献标识码] A [文章编号] 1673-7210(2019)12(b)-0107-06
[Abstract] Objective To systematically evaluate the effect of de-escalation treatment of antibiotic strategy on the patient with ventilator-associated pneumonia (VAP)， so as to optimize VAP anti-infective treatment programs and improve prognosis. Methods The relevant literatures published in China and abroad from January 1995 to December 2017 were retrieved from the databases including PubMed， Cochrane library， EMBASE， CBM， CNKI， and Wangfang database by computer. The key words were ventilator-associated pneumonia， antibacterial drugs， antibiotics， target treatment and de-escalation. The Meta-analysis was performed for the eligible literatures with the Review Manager 5.2 software. The effect of step-down treatment on VAP recurrence rate， mechanical ventilation duration， initial treatment reasonable rate， intensive care unit (ICU) hospitalization time and mortality were evaluated. Results A total of 6 articles were included in the study， with 1293 patients involved， including the de-escalation group with 831 cases and the control group with 462 cases. The relapse rate of VAP in de-escalation group was lower than that in control group (RR = 0.52， 95%CI： 0.34， 0.80)， while the mechanical ventilation duration of de-escalation group was shorter than that in control group (RR = -7.30， 95%CI： -10.97， -3.64)， and the differences were all highly statistically significant (all P < 0.01). However， there were no significant differences in the initial treatment reasonable rate of VAP， ICU hospitalization time， and mortality between the two groups (P > 0.05). Conclusion The de-escalation of antibiotic therapy can decrease the relapse rate of VAP and reduce the mechanical ventilation duration effectively.
[Key words] Ventilator-associated pneumonia; Antibiotic; De-escalation treatment; Meta-analysis, 百拇医药(孙婧婧 郭利涛 马红叶)