中国普外基础与临床杂志

中国普外基础与临床杂志

重症急性胰腺炎预防性应用抗生素效果的 meta 分析

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目的 系统评价预防性应用抗生素对重症急性胰腺炎患者的有效性与安全性。 方法 检索 PubMed、EMbase、Web of Science、Cochrane Library、CNKI 以及万方数据库,并辅以手工检索关于预防性应用抗生素治疗重症急性胰腺炎的随机对照试验,检索时间为数据库建库至 2017 年 12 月。采用 RevMan 5.3 统计软件进行 meta 分析。 结果 共纳入 16 项 RCT 研究,共计 999 例研究对象,其中预防性应用抗生素者(干预组)501 例,接受安慰剂或对照治疗(对照组)498 例。meta 分析结果显示,干预组的胰腺感染率 [OR=0.68,95% CI 为(0.50,0.93),P=0.02] 和胰外感染率 [OR=0.63,95% CI 为(0.45,0.88),P=0.007] 均低于对照组,但 2 组的手术干预率 [OR=0.79,95% CI 为(0.57,1.08),P=0.14] 和死亡率 [OR=0.81,95% CI 为(0.56,1.15),P=0.24] 比较差异均无统计学意义。 结论 预防性应用抗生素有益于降低重症急性胰腺炎患者的胰腺感染率和胰外感染率,但在手术干预率及死亡率方面不具有保护性作用。

Objective To perform a systematic review and meta-analysis to evaluate the efficacy and safety of prophylactic use of antibiotics in preventing severe acute pancreatitis. Methods Randomized control trials (RCTs) of prophylactic use of antibiotics were identified from PubMed, EMbase, Cochrane Library, Web of Science, CNKI, Wangfang Database, and handly searched related literatures. The retrieval time was from inception to Dec. 2017. All the data would be analysis with the software RevMan 5.3. Results Eventually 16 RCTs of 999 participants were involved, the patients were divided into two groups: the intervention group (prophylactic use of antibiotics, n=501) and the control group (n=498). The result of meta-analysis showed that, the incidence rate of pancreatitis infectious disease and the incidence rate of peripancreatitis infectious were significant lower in the intervention group than the control group, whose OR were amount to 0.68 [95% CI was (0.50, 0.93), P=0.02] and 0.63 [95% CI was (0.45, 0.88), P=0.007] respectively. Meanwhile, concerning the rate of surgery intervention [OR=0.79, 95% CI was (0.57, 1.08), P=0.14] and in mortality rate [OR=0.81, 95% CI was (0.56, 1.15), P=0.24], there was no statistically significant. Conclusion Prophylactic antibiotic treatment can do benefit to reduce the incidence rate of pancreatitis infectious and the rate of peripancreatitis infectious disease, but can not reduce mortality in patients with severe acute pancreatitis and had no significant protective effect in patients in reducing the rate of surgery intervention and mortality rate.

关键词: 重症急性胰腺炎; 预防性应用抗生素; meta 分析

Key words: severe acute pancreatitis; prophylactic use of antibiotics; meta-analysis

引用本文: 龚海军, 贺菊芳, 卢存存, 岳伟岗, 田金徽. 重症急性胰腺炎预防性应用抗生素效果的 meta 分析. 中国普外基础与临床杂志, 2018, 25(10): 1218-1226. doi: 10.7507/1007-9424.201804030 复制

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