益生菌制剂预防呼吸机相关性肺炎的系统评价

发布时间：2018-08-25 10:18

【摘要】：目的:系统评价益生菌制剂用于预防呼吸机相关性肺炎(VAP)的有效性和安全性。方法:计算机检索PubMed、Web of Science、Cochrane图书馆、CNKI、CBM和万方等数据库,检索时限从建库至2012年12月,查找益生菌制剂用于预防呼吸机相关性肺炎的随机对照试验(RCT)。按照纳入排除标准选择文献、提取资料和评价纳入研究的方法学质量后,采用Cochrane协作网提供的RevMan 5.1.0软件进行Meta分析。结果:共纳入9个RCT,1 243例患者。Meta分析结果显示:预防性益生菌的使用并不能降低VAP的发生率[RR=0.82,95%CI(0.66,1.01),P=0.06],也不能显著改善以下的结局指标:ICU死亡率[RR=0.88,95%CI(0.64,1.21),P=0.42],住院死亡率[RR=0.78,95%CI(0.58,1.05),P=0.10],ICU住院时间[MD=0.61,95%CI(-2.89,4.01),P=0.73],医院住院时间[MD=-0.99,95%CI(-5.36,3.38),P=0.66],机械通气时间[MD=0.74,95%CI(-2.62,4.10),P=0.67],腹泻发生率[RR=0.91,95%CI(0.77,1.09),P=0.31]以及抗生素使用时间,但可以显著降低呼吸道绿脓杆菌定植率[RR=0.38,95%CI(0.15,0.94)P=0.04]。所有的RCT均无严重不良事件报道。结论:目前有限的证据表明预防用益生菌并不能降低机械通气患者VAP的发生率及死亡率。但鉴于研究设计间存在一定的异质性,以及ICU患者的特殊性,尚需大样本、高质量的随机对照试验来进一步验证。
[Abstract]:Objective: to evaluate the efficacy and safety of probiotics in the prevention of ventilator-associated pneumonia (VAP). Methods: the database of PubMed,Web of Science,Cochrane library was searched by computer. The time limit was from the establishment of the library to December 2012. The (RCT). Of the randomized controlled trial of probiotics to prevent ventilator-associated pneumonia was searched. After selecting the literature according to the inclusion and exclusion criteria, extracting the data and evaluating the methodological quality of the study, the Meta analysis was carried out with the RevMan 5.1.0 software provided by the Cochrane Cooperative Network. Results: a meta-analysis of 9 patients with RCT,1 showed that prophylactic probiotic use could not reduce the incidence of VAP [RR=0.82,95%CI (0.661.01) P0. 06], nor could it significantly improve the mortality rate of RR=0.82,95%CI (0.641.21) P0. 42, and the hospitalization mortality rate (RR=0.78,95%CI (0. 581.05) P0. 10%. [MD=0.61,95%CI (-2.89 卤4.01)], hospital hospitalization time [MD=-0.99,95%CI (-5.36 卤3.38)], mechanical ventilation time [MD=0.74,95%CI (-2.62 卤4.10) MD=0.74,95%CI (-2.62 卤4.10) MD=0.74,95%CI 0.67], incidence of diarrhea [RR=0.91,95%CI (0.771.09) P0.31] and time of antibiotic use, But the colonization rate of Pseudomonas aeruginosa in respiratory tract [RR=0.38,95%CI _ (0.15) 0.94) P _ (0.04) was significantly decreased. No serious adverse events were reported in all RCT. Conclusion: there is limited evidence that probiotics can not reduce the incidence and mortality of VAP in patients with mechanical ventilation. But in view of the heterogeneity between the study and design, and the particularity of ICU patients, large sample, high quality randomized controlled trials are needed to further verify.
【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】：R563.1

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