碳青霉烯类抗菌药物延长或持续输注治疗严重感染的疗效及安全性的系统评价

发布时间：2018-03-19 18:46

本文选题：碳青霉烯类抗菌药物　切入点：延长输注　出处：《中国医院药学杂志》2017年16期 　论文类型：期刊论文

【摘要】：目的:系统评价碳青霉烯类抗菌药物延长或持续输注方式(2~4 h输注或持续24 h输注)对比传统间断输注方式(0.5~1 h输注)治疗严重感染的疗效和安全性,以期为临床治疗提供循证参考。方法:计算机检索Cochrane图书馆、EMBase、PubMed、维普中文科技期刊数据库、相关期刊论文、万方数据库,检索碳青霉烯类抗菌药物延长或持续输注方式(观察组)对比间断输注方式(对照组)治疗严重感染的随机对照研究(RCTs),由2位研究者独立筛选文献、提取资料,并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入20个RCTs,合计1 695例患者。Meta分析结果显示:(1)观察组患者临床有效率[RR=1.27,95%CI(1.18,1.36),P0.000 01]和细菌清除率[RR=1.28,95%CI(1.18,1.39),P0.000 01]显著高于对照组,且持续输注的细菌清除效果优于延长输注;(2)观察组的耐药菌产生率显著降低[RR=0.30,95%CI(0.14,0.65),P=0.002];(3)亚组分析显示持续输注组[MD=-6.08,95%CI(-6.68,-5.48),P0.000 01]和延长输注组[MD=-3.06,95%CI(-3.56,-2.56),P0.000 01]均能使ICU住院时间显著缩短;(4)观察组碳青霉烯类抗菌药物用药疗程也显著缩短[MD=-0.76,95%CI(-1.29,-0.22),P=0.005];(5)观察组不良反应发生率[RR=0.98,95%CI(0.70,1.36),P=0.89]与对照组比较,差异无统计学意义;(6)对于呼吸系统感染,与对照组相比,观察组具有较好的临床疗效,且不良反应发生率未增加。结论:与间断输注方式相比,延长或持续输注碳青霉烯类抗菌药物可提高治疗严重感染的疗效,两者安全性相当。上述结论尚需开展更多高质量研究予以验证。
[Abstract]:Objective: to evaluate the efficacy and safety of carbapenem antibiotics in the treatment of severe infection by prolonged or continuous infusion of carbapenem for 4 hours or 24 hours. Methods: to search Cochrane Library for Evidence-Based PubMeddatabase, Weipu Chinese Sci-tech Journal Database, Chinese Journal Full-text Database, Wanfang Database, and to provide evidence-based reference for clinical treatment. A randomized controlled study on the treatment of severe infections with prolonged or continuous carbapenem antibiotics infusion (observation group) and intermittent infusion (control group) was searched. Two researchers independently screened the literature and extracted the data. And to evaluate the bias risks that were included in the study, RevMan 5.3 software was used for Meta analysis. Results: the clinical effective rate [RRN 1.2795] and bacterial clearance rate (RRRN 1.2895CI1.181.181.391P0.00001] in the observation group were significantly higher than those in the control group (P < 0.01), and the results of meta-analysis showed that the clinical effective rate of the observation group was significantly higher than that of the control group (P < 0.05), and the results of meta-analysis showed that the clinical efficacy of the observation group was significantly higher than that of the control group (P < 0.05), and that of the observation group was significantly higher than that of the control group. And the bacterial clearance effect of continuous infusion was better than that of YINGYI 2) the rate of drug-resistant bacteria in the observation group was significantly decreased [RRX 0.3095 CI 0.140.65 P0. 002].) the analysis of the subgroup showed that the continuous infusion group [MD-6.08-95 CI-6.68 -5.48 + P0.00001] and the extended infusion group (MD-3.095CI-3.56-2.56CI-2.56P0.00001] could significantly shorten the hospitalization time of ICU. The course of treatment of carbapenem antibiotics in the observation group was also significantly shorter than that in the control group [MD-0.76 ~ 95% CI-1.29 + -0.22 + P0. 005]) the incidence of adverse reactions in the observation group [RRR0. 98% 95% CI0. 70 + 1. 36 + P0. 89] was also significantly shorter than that in the control group. Compared with the control group, the observation group has better clinical efficacy, and the incidence of adverse reactions does not increase. Conclusion: compared with the intermittent infusion, the observation group has better clinical efficacy than the control group. Prolonged or continuous infusion of carbapenem can improve the efficacy of severe infection, and the safety of the two is the same. These conclusions need to be verified by more high quality research.
【作者单位】：北京大学第三医院药剂科;北京大学药学院药事管理与临床药学系;
【分类号】：R515

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