局部应用庆大霉素胶原海绵预防手术切口感染效果的Meta分析

发布时间：2018-08-16 15:40

【摘要】：目的:系统评价局部应用庆大霉素胶原海绵预防手术切口感染的疗效,为临床提供循证参考。方法:计算机检索Pub Med、EMBase、Cochrane图书馆、中国生物医学文献数据库、相关期刊论文、中文科技期刊数据库、万方数据库收集局部应用庆大霉素胶原海绵(试验组)对比常规手术处理(对照组)预防手术切口感染的随机对照试验(RCT),提取资料并按照改良的Jadad量表评价质量后,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入16项RCT,合计7 752例患者。Meta分析结果显示,试验组患者手术切口感染率显著低于对照组,差异有统计学意义[OR=0.71,95%CI(0.61,0.84),P0.001]。亚组分析发现,心血管系统手术组患者[OR=0.59,95%CI(0.37,0.96),P=0.03]和皮肤软组织手术组患者[OR=0.34,95%CI(0.15,0.75),P=0.008]手术切口感染率均显著低于对照组,差异均有统计学意义;消化系统手术组患者手术切口感染率与对照组比较,差异无统计学意义[OR=0.62,95%CI(0.25,1.54),P=0.30]。术后随访30 d及以内组患者手术切口感染率显著低于对照组[OR=0.58,95%CI(0.41,0.82),P=0.002],差异均有统计学意义;30 d以上组患者手术切口感染率与对照组比较,差异无统计学意义[OR=0.86,95%CI(0.71,1.04),P=0.13]。术后植入胶原海绵含庆大霉素高剂量组(100 mg)患者手术切口感染率显著低于对照组[OR=0.65,95%CI(0.52,0.82),P0.001],差异有统计学意义;低剂量组(≤100 mg)患者手术切口感染率与对照组比较,差异无统计学意义[OR=0.96,95%CI(0.72,1.28),P=0.77]。结论:局部应用庆大霉素胶原海绵可能对预防手术感染有一定作用,并且不同的手术类型、观察时间和庆大霉素使用剂量的预防效果有差异,临床应结合实际谨慎使用。
[Abstract]:Objective: to evaluate the efficacy of local application of gentamicin collagen sponge in the prevention of surgical incision infection. Methods: a computerized search was conducted for the Pub Medtrol EMBase Cochrane Library, the Chinese Biomedical Literature Database, the Chinese Journal Full-text Database, and the Chinese Sci-tech Journal Database. Wanfang database collected local application of gentamicin collagen sponge (trial group) for the prevention of surgical incision infection compared with conventional surgical treatment (control group) of randomized controlled trial (RCT), extraction data and evaluate the quality according to the modified Jadad scale. Meta analysis was carried out with Rev Man 5.3 statistical software. Results: a total of 16 RCTs were included. The results of Meta-analysis showed that the infection rate of surgical incision in the trial group was significantly lower than that in the control group (P 0.001). The results of subgroup analysis showed that the incision infection rate in the cardiovascular system operation group [ORO 0.59 卤9595 CI (0.37 卤0.96) P0. 03] and the skin and soft tissue operation group [ORG 0.34 95 CI (0. 15 + 0. 75) P 0. 008] was significantly lower than that in the control group (P 0. 008, P 0. 008). The infection rate of surgical incision in the digestive system operation group was not significantly different from that in the control group [ORO 0.62 卤95 CI (0.25 卤1.54) P < 0.30]. The infection rate of surgical incision in the patients within 30 days after operation was significantly lower than that in the control group [ORO 0.5895 CI (0.41U 0.82) P 0.002]. There was no significant difference in the infection rate of surgical incision between the patients of the group over 30 days after operation and the control group [OR0.86 + 95CI (0.711.04) P 0.13]. The operative incision infection rate in the high dose group (100 mg) with collagen sponge implantation was significantly lower than that in the control group [ORO 0.65J 95 CI (0.52U 0.82) P 0.001], and the infection rate in the low dose group (鈮，

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