本文選題：呼吸機相關(guān)性肺炎 + 霧化吸入　； 參考：《重慶醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的采用薈萃分析方法對國內(nèi)外已發(fā)表的關(guān)于霧化吸入抗生素聯(lián)合靜脈抗生素治療與單用靜脈抗生素對呼吸機相關(guān)性肺炎患者的臨床治療有效率、死亡率、并發(fā)癥及是否有利于患者脫機等情況的文獻綜合分析，并進行數(shù)據(jù)合并，評價霧化吸入抗生素對呼吸機相關(guān)性肺炎治療的影響。 方法英文文獻在pubmed、medline、cochrane圖書館、ovid、Elsevier等數(shù)據(jù)庫檢索，中文文獻在中國生物醫(yī)學(xué)期刊數(shù)據(jù)庫、萬方數(shù)據(jù)庫、中國全文數(shù)據(jù)庫等網(wǎng)絡(luò)資源中檢索，，限制檢索時間為1990年1月到2013年3月，并逐一查閱所納入文獻的參考文獻。外文關(guān)鍵詞包括：inhaled antimicrobials, aerosolized or nebulized or endotracheal antibiotics“ventilator-associated pneumonia”。未限制語言，設(shè)定限制對象為“人”，且設(shè)定試驗類型為隨機對照，在檢索中文文獻時，以相應(yīng)的中文檢索詞為主題詞。同時輔以手工檢索方法。納入比較了霧化吸入聯(lián)合靜脈抗生素對呼吸機相關(guān)性肺炎治療影響的隨機對照試驗，并由另外2名評價員通過Jadad量表評價文獻質(zhì)量，利用review manager5.2軟件進行χ2檢驗和計算I2值以評價文獻間的異質(zhì)性，從而獨立地對文獻進行評價、篩查及提取。通過軟件所計算的P值及I2值選擇研究效應(yīng)模型，對所得陽性結(jié)果進一步做敏感性分析評價研究結(jié)果的可靠性，對各研究間異質(zhì)性較大而不能行數(shù)據(jù)合并者做描述性分析。 結(jié)果經(jīng)納入及排除標(biāo)準(zhǔn)篩選，此篇Meta納入隨機對照研究5篇，共231患者，其中霧化吸入聯(lián)合靜脈抗生素組116例，單用靜脈抗生素組115例。經(jīng)過Jadad量表評分5篇均為高于4分的高質(zhì)量文獻，薈萃分析研究結(jié)果顯示：(1)臨床治療有效方面：對呼吸機相關(guān)性肺炎患者行霧化聯(lián)合靜脈抗生素可以提高臨床治療有效率：RR=1.33,95%CI（1.02，1.74），P=0.03＜0.05；但較單用靜脈抗生素組并不能降低患者的死亡率：RR=1.02，95%CI(0.67,1.53)，P=0.94；(2)耐藥性方面：行數(shù)據(jù)合并后不難發(fā)現(xiàn)，霧化聯(lián)合靜脈抗生素治療呼吸機相關(guān)性肺炎患者并不會增加其細菌耐藥性風(fēng)險：RR=0.34,95%CI（0.02，5.57），P=0.45＞0.05（3）機械通氣脫機方面：霧化吸入抗生素聯(lián)合靜脈抗生素較單用靜脈抗生素并不能促進機械通氣并呼吸機相關(guān)性患者脫機：RR=1.74,95%CI（0.99，3.07），P=0.05（4）并發(fā)癥方面：霧化吸入聯(lián)合靜脈使用抗生素較單用靜脈抗生素并不會增加患者血清肌酐濃度：MD=-0.30,95%CI（-0.91,0.31），P=0.34，亦不會增加發(fā)生支氣管痙攣的風(fēng)險：RR=2.27,95%CI（0.46,11.08），P=0.31，即呼吸機相關(guān)性肺炎的患者對霧化吸入抗生素有比較好的耐受性。 結(jié)論（1）呼吸機相關(guān)性肺炎患者予以霧化吸入聯(lián)合靜脈抗生素較單用靜脈抗生素能提高患者臨床治療有效率，但不能降低患者死亡率；（2）霧化吸入聯(lián)合靜脈抗生素較單用靜脈抗生素不能促進機械通氣患者脫機；（3）呼吸機相關(guān)性肺炎患者對霧化吸入抗生素有較好的耐受性，較單用靜脈抗生素者不會增加血清中肌酐濃度，亦不會增加支氣管痙攣及產(chǎn)生耐藥菌群的風(fēng)險。
[Abstract]:Objective to evaluate the effectiveness, mortality, complications and benefits of patients with ventilator-associated pneumonia by using a meta-analysis method, which is published at home and abroad, in combination with intravenous antibiotics and single intravenous antibiotics for patients with ventilator-associated pneumonia. The effect of aerosol inhalation on the treatment of ventilator-associated pneumonia.
Methods the English literature was retrieved in the PubMed, MEDLINE, Cochrane Library, Ovid, Elsevier and other databases. The Chinese literature was retrieved in the Chinese biomedical journal database, Wanfang database, Chinese full text database and other network resources. The restricted retrieval time was from January 1990 to March 2013, and the references were consulted one by one. Key words include: inhaled antimicrobials, aerosolized or nebulized or endotracheal antibiotics "ventilator-associated pneumonia". Unrestricted language, set Limited object as "human", and set the test type as random control, in the retrieval of Chinese literature, the Chinese retrieval words should be subject to the subject. A randomized controlled trial was taken to compare the effects of aerosol inhalation combined with intravenous antibiotics on the treatment of ventilator-associated pneumonia, and the quality of literature was evaluated by 2 other evaluators by the Jadad scale, and the review manager5.2 software was used for the chi 2 test and the calculation of I2 values to evaluate the heterogeneity between the articles, and the literature was independently carried out. Evaluation, screening and extraction. The study effect model was selected through the P value and I2 value calculated by the software. The reliability of the results was further evaluated by the sensitivity analysis of the positive results.
Results after inclusion and exclusion criteria, the Meta included 5 randomized controlled studies, including 231 patients, 116 with nebulization inhalation combined with intravenous antibiotics, 115 in a single intravenous antibiotic group. 5 were higher than 4 scores by the Jadad scale. The results of meta analysis showed that: (1) effective aspects of clinical treatment: (1) Patients with ventilator-associated pneumonia combined with nebulization and intravenous antibiotics can improve the effectiveness of clinical treatment: RR=1.33,95%CI (1.02,1.74), P=0.03 < 0.05; but compared with the single intravenous antibiotic group, the mortality of patients can not be reduced: RR=1.02,95%CI (0.67,1.53), P=0.94; (2) drug resistance: the combination of data is not difficult to find, nebulization is not difficult to find. Intravenous antibiotic therapy in patients with ventilator associated pneumonia does not increase the risk of bacterial resistance: RR=0.34,95%CI (0.02,5.57), P=0.45 > 0.05 (3) mechanical ventilation offline: atomization inhalation antibiotics combined with intravenous antibiotics compared with intravenous antibiotics alone can not promote mechanical ventilation and ventilator related patients offline: RR=1.7 4,95%CI (0.99,3.07), P=0.05 (4) complications: atomization inhalation combined with intravenous antibiotics compared with intravenous antibiotics alone does not increase serum creatinine concentration in patients: MD=-0.30,95%CI (-0.91,0.31), P=0.34, and does not increase the risk of bronchospasm: RR= 2.27,95%CI (0.46,11.08), P=0.31, or ventilator-associated pneumonia The aerosol inhalation resistance was well tolerated.
Conclusions (1) aerosol inhalation combined with intravenous antibiotics in patients with ventilator associated pneumonia can improve the clinical efficacy of patients with intravenous antibiotics but can not reduce the mortality of patients. (2) aerosol inhalation combined with intravenous antibiotics can not promote mechanical ventilation in patients with mechanical ventilation than intravenous antibiotics alone; (3) ventilator-associated pneumonia The patient has a better tolerance to the inhalation of antibiotics and does not increase the concentration of creatinine in the serum and does not increase the risk of bronchospasm and drug resistance.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R563.1

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