降钙素原指导抗生素策略对脓毒症患者抗菌药物使用的效果评价

发布时间：2018-05-11 08:35

本文选题：降钙素原 + 脓毒症　；参考：《中国现代医学杂志》2016年09期

【摘要】：目的评价降钙素原(PCT)指导抗生素策略在脓毒症患者中应用的有效性,为临床决策提供参考依据。方法计算机检索Pub Med、EMbase、the Cochrane Library、Web of Science、CBMdisc、CNKI和万方数据库,收集关于PCT指导抗生素治疗脓毒症患者有效性的临床随机对照试验(RCT),检索时间从建库至2015年3月。由2位研究者按纳入标准独立筛选文献、提取资料并评价质量后,采用Rev Man 5.3软件进行Meta分析。结果纳入10个RCT,共1 620例患者。Meta分析结果提示,与常规治疗组比较,PCT指导组能够缩短抗生素使用时间和总住院时间[MD_1=-1.41,(95%CI_1:-2.15,-0.68),P_1=0.000;MD_2=-2.98,(95%CI_2:-4.92,-1.05),P_2=0.002],而在院内病死率、28 d病死率和ICU住院时间方面比较,差异无统计学意义[RR1=0.98,(95%CI1:0.72,1.33),P_1=0.090;RR_2=1.03,(95%CI_2:0.85,1.24),P_2=0.770;MD_3=-0.01,(95%CI_3:-0.27,0.25),P_3=0.930]。结论 PCT指导抗生素策略能够缩短脓毒症患者的抗生素使用时间和总住院时间,而对院内病死率和28 d死亡率无明显影响。但尚需大样本、高质量的RCT验证。
[Abstract]:Objective to evaluate the effectiveness of the application of procalcitonin (PCT)-guided antibiotic strategy in patients with sepsis and to provide reference for clinical decision-making. Methods the Pub Medbase of Cochrane Library Pub and Wanfang database were searched, and the clinical randomized controlled trials on the effectiveness of PCT in the treatment of sepsis were collected. The retrieval time was from the establishment of the database to March 2015. According to the inclusion criteria, two researchers independently sifted the literature, extracted the data and evaluated the quality, and then analyzed the data with Rev Man 5.3 software. Results A meta-analysis of 1 620 patients with 10 RCTs showed that compared with the routine treatment group, the PCT-guided group was able to shorten the antibiotic use time and total hospitalization time [MD1 / 1. 41 1 + 95 CI95: 1: -2.15 + -0. 68% P 1: 1 0. 000 and MD2- 2. 98 95 CI2: 4.92% -1 05% -1 05% P5 + 20.002], while the mortality rate of 28 days in the hospital and the length of ICU stay in hospital were higher than those in the PCT steering group (P < 0. 002), and compared with that in the normal treatment group (P < 0. 05), but the mortality rate in the hospital was 28 days compared with that in the control group (P < 0. 002), and the mortality rate in the hospital was 28 days. There was no statistical difference [RR1 / 0.988 / 95CI1: 0.72C / 1.33 / R10.090 / RR21.03C / 95CI95: 0: 2: 0.851.24C P 20.7700.70 MD3U -0.01 + 95C + 95]. [RR1: 0. 090 / RR1: 0. 090 / RR1: 0. 078 / 95CI3: 0. 27 0.27 0.25 in CI3 / 0. 30.) Conclusion the antibiotic strategy guided by PCT can shorten the antibiotic use time and total hospitalization time of sepsis patients, but has no significant effect on hospital mortality and 28 days mortality. But still need large sample, high quality RCT verification.
【作者单位】：江苏省常州市第四人民医院急诊科;
【分类号】：R459.7

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