系统评价万古霉素联合地塞米松鞘内注射治疗颅内感染的有效性和安全性

发布时间：2018-03-24 16:03

本文选题：万古霉素　切入点：地塞米松　出处：《中国药房》2017年12期

【摘要】：目的:系统评价万古霉素联合地塞米松鞘内注射治疗颅内感染的临床疗效和安全性,为临床提供循证参考。方法:计算机检索Pub Med、Medline、相关期刊论文、中文科技期刊数据库和万方数据库,收集万古霉素联合地塞米松鞘内注射治疗颅内感染的随机对照试验(RCT)。由两位评价员独立筛选文献、提取资料并按照Cochrane系统评价员手册5.0.1版评价纳入研究的偏倚风险后,采用Rev Man 5.2统计软件进行Meta分析。结果:最终纳入8项RCT,合计543例患者。Meta分析结果显示,与头孢曲松钠或万古霉素静脉滴注相比,万古霉素联合地塞米松鞘内注射可明显提高颅内感染患者有效率[RR=1.18,95%CI(1.11,1.26),P0.001]和脑脊液细菌清除率[RR=1.13,95%CI(1.01,1.27),P0.001],缩短临床治疗时间[SMD=-1.60,95%CI(-1.89,-1.30),P0.001],减少不良反应发生率[RR=0.48,95%CI(0.32,0.73),P0.001],同时还能明显改善患者颅内压[SMD=-1.78,95%CI(-2.10,-1.47),P0.001]、脑脊液蛋白定量[SMD=-0.18,95%CI(-0.25,-0.11),P0.001]和脑脊液葡萄糖定量[SMD=1.77,95%CI(0.91,2.63),P0.001],差异均有统计学意义。结论:万古霉素联合地塞米松鞘内注射治疗颅内感染临床疗效较好,可以提高脑脊液细菌清除率,缩短治疗时间,降低患者颅内压和脑脊液蛋白定量,提高脑脊液葡萄糖定量,且安全性较好。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of vancomycin combined with dexamethasone intrathecal injection in the treatment of intracranial infection and to provide evidence based reference for clinical practice. Methods: Pub Medline, full text database of Chinese Journal, was searched by computer. A randomized controlled trial of vancomycin combined with dexamethasone intrathecal injection in the treatment of intracranial infection was conducted in the Chinese Science and Technology Journal database and the Wanfang database. The literature was screened by two evaluators. After extracting the data and including the bias risk of the study according to the evaluation of 5.0.1 edition of the Cochrane system evaluator manual, the Meta analysis was carried out with Rev Man 5.2 statistical software. Results: finally, 8 RCTs were included, and a total of 543 patients. Meta-analysis results showed that, Compared with ceftriaxone sodium or vancomycin intravenous drip, Vancomycin combined with intrathecal injection of dexamethasone can significantly improve the effective rate of intracranial infection patients [RRN 1.1895 CII 1.111.26 + P0.001] and cerebrospinal fluid bacterial clearance rate [RRR1.1395CII 1.01U 1.27p0.001], shorten the clinical treatment time [SMD-1.6095CI-1.89C- 1.30NV P0.001], reduce the incidence of adverse reactions [RRR0.4895 CI 0.320.73KP0.001], and also significantly improve the intracranial symptoms of the patients. The pressure [SMD-1.78C95], cerebrospinal fluid protein quantification [SMD-0.18 ~ 95CI-0.25CI-0.11] and cerebrospinal fluid glucose (SMD-1.795 CI 0.912.63 / P0.001) were significantly different. Conclusion: vancomycin combined with dexamethasone intrathecal injection is more effective in the treatment of intracranial infection. It can improve the bacterial clearance rate of cerebrospinal fluid, shorten the time of treatment, reduce the intracranial pressure and cerebrospinal fluid protein quantification, and increase the amount of cerebrospinal fluid glucose, and the safety is good.
【作者单位】：哈励逊国际和平医院药学部;
【分类号】：R742.9

【相似文献】