降钙素原导向的抗生素使用对重症患者抗感染疗效及预后影响的Meta分析

发布时间：2018-05-21 02:42

本文选题：降钙素原 + 重症　；参考：《中国呼吸与危重监护杂志》2016年05期

【摘要】：目的系统性评价降钙素原(PCT)导向的抗生素使用对重症患者抗感染疗程、抗生素不良反应及临床预后的影响。方法计算机检索和手工检索收集有关PCT指导重症患者抗感染治疗的原始研究文献,按纳入与排除标准选择文献,评价纳入文献质量,提取资料,采用Rev Man 5.3软件对数据进行Meta分析。结果共纳入8篇文献,全部为随机对照临床试验(RCT)研究。8篇研究共入选2 708例患者,其中PCT导向组1 360例,经验性使用组1 348例。Meta分析显示,与经验性使用组相比,PCT导向组抗生素疗程明显缩短[平均差(MD)=-2.44,95%可信区间(95%CI)-3.25~-1.62,P0.000 01];且PCT导向组抗生素不良反应发生率显著降低[相对危险度(RR)=0.74,95%CI 0.56~0.97,P=0.03],但PCT导向组患者病死率并无显著下降[RR=1.00,95%CI 0.89~1.13,P=0.99]。结论与经验性使用抗生素相比,PCT导向的抗感染方案可以显著缩短重症患者抗生素疗程,降低抗生素不良反应发生率,但对重症患者的病死率无明显影响。
[Abstract]:Objective to systematically evaluate the effects of procalcitonin PCT- directed antibiotic use on the course of anti-infection, adverse drug reactions and clinical prognosis in severe patients. Methods the original literatures about PCT guiding antiinfective therapy in severe patients were collected by computer retrieval and manual retrieval. According to the criteria of inclusion and exclusion, the quality of the literature was evaluated and the data were extracted. The data were analyzed by Meta using Rev Man 5.3 software. Results two hundred and seventy eight patients were included in this study, including 1 360 in PCT guidance group and 1 348 in experiential use group. Meta analysis showed that there were 2 708 patients in this study. The course of antibiotic treatment in the PCT-guided group was significantly shorter than that in the experiential use group [mean MD-2.44V 95% CI = 95CI-3.25- 1.62P0.00001], and the incidence of adverse antibiotic reactions in the PCT guided group was significantly reduced [relative risk: RRT0.7495 CI 0.560.97P0.03], but the mortality rate of the PCT guided group was significantly lower than that of the PCT guided group. There was no significant decrease [RRN 1.00 95 CI 0.89 1.13 P0. 99]. Conclusion compared with the empirical use of antibiotics, PCT-guided antiinfective regimen can significantly shorten the course of antibiotic treatment and reduce the incidence of adverse reactions of antibiotics, but has no significant effect on the mortality of severe patients.
【作者单位】：南京医科大学附属无锡人民医院重症医学科;南京医科大学附属无锡人民医院教育处;南京医科大学附属无锡人民医院药剂科;
【基金】：国家自然科学基金(编号:81400054) 江苏省自然科学基金(编号:BK 20140122) 无锡市科技局项目(编号:CSE31N1503) 无锡市卫生局妇幼保健项目(编号:FYKY201405)
【分类号】：R459.7

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