摘要
目的 探讨重症急性胰腺炎（SAP）患者预防性抗感染治疗的作用.方法 计算机检索和手工检索收集1990年1月～2011年4月预防性抗感染治疗SAP的英文和中文临床随机对照研究,按纳入与排除标准选择文献,提取资料,应用RevMan 5.0软件对数据进行Meta分析,对预防性抗生素治疗SAP临床研究进行系统评价.结果 纳入随机对照研究10篇,共有SAP患者599例,其中304例随机给予预防性抗生素.分析显示,在SAP患者中预防性使用抗生素可以降低胰外感染的发生率[相对危险度（RR）为0.67,95％可信区间为0.46～0.99,P=0.04],但病死率（P＝0.26）、胰腺感染（P=0.06）和手术干预（P=0.19）发生率均不能降低.亚组分析显示在高质量和多中心组预防性使用抗生素可以降低胰外感染的发生率,P值分别为0.03和0.0003,其余各亚组中病死率、胰腺感染、手术干预及胰外感染的发生率均不能降低.结论 预防性使用抗生素治疗不能改善病死率,亦不能降低胰腺感染和手术干预的发生率,但可能降低了胰腺外感染发生率.
Objective To investigate the effects of prophylactic antibiotic in adult with severe a- cute pancreatitis（SAP）. Methods We searched the English and Chinese literatures about prophylactic antibiotic treatment on acute severe pancreatitis by manual and computer,searching from January 1990 to April 2011 and identified clinical randomized controlled trials by inclusion and exclusion criteria. Meta an- alyses of the effects of prophylactic antibiotic in adult with severe acute pancreatitis（SAP） were conducted using RevMan 5.0 software recommended by the Cochrane Collaboration. Results Ten trials involving 599 patients were included,304 were randomized to receive prophylactic antibiotics. Analysis showed that prophylactic use of antibiotics can significantly reduce the incidence of nonpancreatic infection（ RR 0.67, 95 % confidence interval 0.46-0.99, P = 0.04）, but mortality （ P = 0.26）, the incidence rate of pancreatic infection（P = 0.06） and surgical intervention（ P = 0.19） can not be reduced. Subgroup analysis showed that antibiotic prophylaxis can reduced the incidence of nonpancreatic infection in high-quality and multi- center groups, P values were respectively 0.03,0. 0003, however, mortality, incidence of pancreatic infec- tion, surgical intervention and nonpancreatic infection could not be reduced in the remaining sub-groups. Conclusion Prophylactic antibiotic therapy does not improve mortality, also could not reduce the inci- dence of pancreatic infection and surgical intervention, but may reduce the incidence of nonpancreatic in- fection.
出处
《临床内科杂志》
CAS
2014年第2期101-104,共4页
Journal of Clinical Internal Medicine
基金
中央高校基本科研业务费自由探索项目（自然科学类）（lzujbky-2010-202）
关键词
重症急性胰腺炎
抗生素
随机对照
META分析
Severe acute pancreatitis
Antibiotics
Randomized controlled
Meta Analysi
