雾化吸入联合静脉抗生素与单用静脉抗生素对呼吸机相关性肺炎的影响-Meta分析

发布时间：2018-07-01 12:37

本文选题：呼吸机相关性肺炎 + 雾化吸入　；参考：《重庆医科大学》2013年硕士论文

【摘要】：目的采用荟萃分析方法对国内外已发表的关于雾化吸入抗生素联合静脉抗生素治疗与单用静脉抗生素对呼吸机相关性肺炎患者的临床治疗有效率、死亡率、并发症及是否有利于患者脱机等情况的文献综合分析，并进行数据合并，评价雾化吸入抗生素对呼吸机相关性肺炎治疗的影响。方法英文文献在pubmed、medline、cochrane图书馆、ovid、Elsevier等数据库检索，中文文献在中国生物医学期刊数据库、万方数据库、中国全文数据库等网络资源中检索，，限制检索时间为1990年1月到2013年3月，并逐一查阅所纳入文献的参考文献。外文关键词包括：inhaled antimicrobials, aerosolized or nebulized or endotracheal antibiotics“ventilator-associated pneumonia”。未限制语言，设定限制对象为“人”，且设定试验类型为随机对照，在检索中文文献时，以相应的中文检索词为主题词。同时辅以手工检索方法。纳入比较了雾化吸入联合静脉抗生素对呼吸机相关性肺炎治疗影响的随机对照试验，并由另外2名评价员通过Jadad量表评价文献质量，利用review manager5.2软件进行χ2检验和计算I2值以评价文献间的异质性，从而独立地对文献进行评价、筛查及提取。通过软件所计算的P值及I2值选择研究效应模型，对所得阳性结果进一步做敏感性分析评价研究结果的可靠性，对各研究间异质性较大而不能行数据合并者做描述性分析。结果经纳入及排除标准筛选，此篇Meta纳入随机对照研究5篇，共231患者，其中雾化吸入联合静脉抗生素组116例，单用静脉抗生素组115例。经过Jadad量表评分5篇均为高于4分的高质量文献，荟萃分析研究结果显示：(1)临床治疗有效方面：对呼吸机相关性肺炎患者行雾化联合静脉抗生素可以提高临床治疗有效率：RR=1.33,95%CI（1.02，1.74），P=0.03＜0.05；但较单用静脉抗生素组并不能降低患者的死亡率：RR=1.02，95%CI(0.67,1.53)，P=0.94；(2)耐药性方面：行数据合并后不难发现，雾化联合静脉抗生素治疗呼吸机相关性肺炎患者并不会增加其细菌耐药性风险：RR=0.34,95%CI（0.02，5.57），P=0.45＞0.05（3）机械通气脱机方面：雾化吸入抗生素联合静脉抗生素较单用静脉抗生素并不能促进机械通气并呼吸机相关性患者脱机：RR=1.74,95%CI（0.99，3.07），P=0.05（4）并发症方面：雾化吸入联合静脉使用抗生素较单用静脉抗生素并不会增加患者血清肌酐浓度：MD=-0.30,95%CI（-0.91,0.31），P=0.34，亦不会增加发生支气管痉挛的风险：RR=2.27,95%CI（0.46,11.08），P=0.31，即呼吸机相关性肺炎的患者对雾化吸入抗生素有比较好的耐受性。结论（1）呼吸机相关性肺炎患者予以雾化吸入联合静脉抗生素较单用静脉抗生素能提高患者临床治疗有效率，但不能降低患者死亡率；（2）雾化吸入联合静脉抗生素较单用静脉抗生素不能促进机械通气患者脱机；（3）呼吸机相关性肺炎患者对雾化吸入抗生素有较好的耐受性，较单用静脉抗生素者不会增加血清中肌酐浓度，亦不会增加支气管痉挛及产生耐药菌群的风险。
[Abstract]:Objective to evaluate the effectiveness, mortality, complications and benefits of patients with ventilator-associated pneumonia by using a meta-analysis method, which is published at home and abroad, in combination with intravenous antibiotics and single intravenous antibiotics for patients with ventilator-associated pneumonia. The effect of aerosol inhalation on the treatment of ventilator-associated pneumonia.
Methods the English literature was retrieved in the PubMed, MEDLINE, Cochrane Library, Ovid, Elsevier and other databases. The Chinese literature was retrieved in the Chinese biomedical journal database, Wanfang database, Chinese full text database and other network resources. The restricted retrieval time was from January 1990 to March 2013, and the references were consulted one by one. Key words include: inhaled antimicrobials, aerosolized or nebulized or endotracheal antibiotics "ventilator-associated pneumonia". Unrestricted language, set Limited object as "human", and set the test type as random control, in the retrieval of Chinese literature, the Chinese retrieval words should be subject to the subject. A randomized controlled trial was taken to compare the effects of aerosol inhalation combined with intravenous antibiotics on the treatment of ventilator-associated pneumonia, and the quality of literature was evaluated by 2 other evaluators by the Jadad scale, and the review manager5.2 software was used for the chi 2 test and the calculation of I2 values to evaluate the heterogeneity between the articles, and the literature was independently carried out. Evaluation, screening and extraction. The study effect model was selected through the P value and I2 value calculated by the software. The reliability of the results was further evaluated by the sensitivity analysis of the positive results.
Results after inclusion and exclusion criteria, the Meta included 5 randomized controlled studies, including 231 patients, 116 with nebulization inhalation combined with intravenous antibiotics, 115 in a single intravenous antibiotic group. 5 were higher than 4 scores by the Jadad scale. The results of meta analysis showed that: (1) effective aspects of clinical treatment: (1) Patients with ventilator-associated pneumonia combined with nebulization and intravenous antibiotics can improve the effectiveness of clinical treatment: RR=1.33,95%CI (1.02,1.74), P=0.03 < 0.05; but compared with the single intravenous antibiotic group, the mortality of patients can not be reduced: RR=1.02,95%CI (0.67,1.53), P=0.94; (2) drug resistance: the combination of data is not difficult to find, nebulization is not difficult to find. Intravenous antibiotic therapy in patients with ventilator associated pneumonia does not increase the risk of bacterial resistance: RR=0.34,95%CI (0.02,5.57), P=0.45 > 0.05 (3) mechanical ventilation offline: atomization inhalation antibiotics combined with intravenous antibiotics compared with intravenous antibiotics alone can not promote mechanical ventilation and ventilator related patients offline: RR=1.7 4,95%CI (0.99,3.07), P=0.05 (4) complications: atomization inhalation combined with intravenous antibiotics compared with intravenous antibiotics alone does not increase serum creatinine concentration in patients: MD=-0.30,95%CI (-0.91,0.31), P=0.34, and does not increase the risk of bronchospasm: RR= 2.27,95%CI (0.46,11.08), P=0.31, or ventilator-associated pneumonia The aerosol inhalation resistance was well tolerated.
Conclusions (1) aerosol inhalation combined with intravenous antibiotics in patients with ventilator associated pneumonia can improve the clinical efficacy of patients with intravenous antibiotics but can not reduce the mortality of patients. (2) aerosol inhalation combined with intravenous antibiotics can not promote mechanical ventilation in patients with mechanical ventilation than intravenous antibiotics alone; (3) ventilator-associated pneumonia The patient has a better tolerance to the inhalation of antibiotics and does not increase the concentration of creatinine in the serum and does not increase the risk of bronchospasm and drug resistance.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.1

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