【摘要】：目的： 采用Cochrane系統(tǒng)評價方法對阿米卡星聯(lián)合抗假單胞菌p-內(nèi)酰胺類抗菌藥物初始經(jīng)驗性治療醫(yī)院獲得性肺炎(Hospital acquired pneumonia, HAP)的有效性和安全性進(jìn)行評價。 方法： 按照Cochrane Collaboration的標(biāo)準(zhǔn),計算機(jī)全面檢索CENTRAL (Cochrane圖書館臨床對照試驗中心數(shù)據(jù)庫,2012年第7期)、MEDLINE (1950～2012.11)、EMBASE (1980～2012.11)、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM,1970～2012.11)、中國期刊網(wǎng)全文數(shù)據(jù)庫(CNKI,1970～2012.11)、維普數(shù)據(jù)庫(VIP,1970～2012.11)、會議資料及互聯(lián)網(wǎng)資料,檢索不限語種,收集阿米卡星聯(lián)合抗假單胞菌β-內(nèi)酰胺類抗菌藥物經(jīng)驗性治療HAP的臨床隨機(jī)對照實驗(Randomized controlled trials, RCT)。由兩名系統(tǒng)評價員獨立篩選納入的研究并評價偏倚風(fēng)險,提取相關(guān)資料進(jìn)行交叉核對,如有意見分歧可經(jīng)討論或由具有相關(guān)專業(yè)知識的第三入仲裁。采用治療有效率、失敗率、細(xì)菌學(xué)清除率、銅綠假單胞菌清除率、二重感染率、死亡率及不良反應(yīng)發(fā)生率為結(jié)局指標(biāo)對阿米卡星聯(lián)合抗假單胞菌p-內(nèi)酰胺類抗菌藥物經(jīng)驗性治療HAP的療效和安全性進(jìn)行評估。運用RevMan5.2軟件對數(shù)據(jù)進(jìn)行統(tǒng)計分析。 結(jié)果： 最終共納入6個RCT,703例HAP患者。2個研究質(zhì)量較高,4個研究質(zhì)量較低。統(tǒng)計分析結(jié)果如下： 1.阿米卡星聯(lián)合頭孢他啶VS美羅培南單用：阿米卡星聯(lián)合頭孢他啶經(jīng)驗性治療HAP的臨床治療失敗率高于美羅培南,有統(tǒng)計學(xué)差異[RR=1.73,95%CI(1.01,2.98)]；在臨床治療有效率、細(xì)菌學(xué)清除率、銅綠假單胞菌清除率、二重感染率、死亡率、不良反應(yīng)發(fā)生率方面兩組無統(tǒng)計學(xué)差異(結(jié)果分別為RR=0.82,95％CI(0.67,1.01)；RR=0.82,95％CI(0.67,1.01)；RR=0.87,95％CI(0.58,1.31)；RR=1.12,95％CI(0.66,1.92)； RR=0.58,95％CI(0.14,2.35)；RR=1.21,95％CI(0.69,2.14)；RR=1.11,95％CI(0.43,2.90)). 2.阿米卡星聯(lián)合抗假單胞菌B-內(nèi)酰胺類菌藥物VS喹諾酮類抗菌藥物聯(lián)合抗假單胞菌β-內(nèi)酰胺類藥物：阿米卡星聯(lián)合抗假單胞菌β-內(nèi)酰胺類菌藥物經(jīng)驗性治療HAP的細(xì)菌清除率優(yōu)于喹諾酮類抗菌藥物聯(lián)用抗假單胞菌β-內(nèi)酰胺類藥物,有統(tǒng)計學(xué)意義[RR=1.34,95%CI(1.07,1.67)]；在銅綠假單胞菌清除率、二重感染率、死亡率方面兩組無統(tǒng)計學(xué)差異(結(jié)果分別為RR=1.13,95％CI(0.74,1.73)；RR=1.05,95％CI(0.24,4.59)；RR=0.88,95％CI(0.55,1.43)). 3.阿米卡星聯(lián)合頭孢吡肟VS頭孢吡肟單用：阿米卡星聯(lián)合頭孢吡肟經(jīng)驗性治療HAP的臨床有效率、細(xì)菌清除率優(yōu)于頭孢吡肟單用,有統(tǒng)計學(xué)差異(結(jié)果分別為RR=1.25,95％CI(1.09,1.45)；RR=l.32,95％CI(1.09,1.59)；失敗率低于頭孢吡肟單用,有統(tǒng)計學(xué)差異[RR=0.38,95%CI(0.20,0.72)]；在銅綠假單胞菌清除率、二重感染率、死亡率方面兩組并無統(tǒng)計學(xué)差異(結(jié)果分別為RR=1.29,95％CI(0.9,1.72)；RR=3.16,95％CI(0.36,27.78)；RR=1.85,95％CI(0.37,9.18)). 結(jié)論： 本系統(tǒng)評價顯示了阿米卡星聯(lián)用抗假單胞菌p-內(nèi)酰胺類菌藥物經(jīng)驗性治療HAP的有效性和安全性,所支持的證據(jù)質(zhì)量級別低,為弱推薦。納入的研究數(shù)量少,樣本量小,且大部分研究方法學(xué)質(zhì)量不高,需更多高質(zhì)量大規(guī)模的RCT,應(yīng)用證據(jù)時應(yīng)謹(jǐn)慎。
[Abstract]:Objective:
The effectiveness and safety of the initial empirical treatment of hospital acquired pneumonia (Hospital acquired pneumonia, HAP) with Amikacin combined with anti Pseudomonas p- lactam antibiotics was evaluated by the Cochrane system evaluation method.
Method:
According to the standard of Cochrane Collaboration, the computer completely retrieves CENTRAL (Cochrane library clinical controlled trial center database, seventh period 2012), MEDLINE (1950 ~ 2012.11), EMBASE (1980 ~ 2012.11), Chinese biomedical literature database (CBM, 1970 to 2012.11), Chinese Journal Network full text database (CNKI, 1970 to 2012.11), VP number According to the library (VIP, 1970 ~ 2012.11), conference data and Internet data, retrieval of non limited languages, the clinical randomized controlled trial (Randomized controlled trials, RCT) for the empirical treatment of HAP for beta lactam antibiotics against Pseudomonas aeruginosa (Randomized trials, RCT) was collected and the risk of bias was evaluated by two independent evaluators. Cross check the relevant data, such as disagreement can be discussed or third into arbitration with relevant professional knowledge. Treatment efficiency, failure rate, bacteriological clearance rate, Pseudomonas aeruginosa clearance rate, double infection rate, mortality and adverse reaction rate are the outcome indicators of Amikacin combined with anti Pseudomonas p- The efficacy and safety of empirical treatment of HAP with lactam antibiotics were evaluated. RevMan 5.2 software was used to analyze the data.
Result:
Finally, a total of 6 RCT and 703 HAP patients were included in the study. The quality of.2 research was higher and the quality of the 4 studies was lower.
1. Amikacin combined with ceftazidime VS meropenem: the clinical treatment failure rate of Amikacin combined with ceftazidime was higher than meropenem, with a statistically significant difference of [RR=1.73,95%CI (1.01,2.98)]; in clinical treatment, bacteriological clearance rate, Pseudomonas aeruginosa clearance rate, double infection rate, mortality, and bad condition There were no statistical differences between the two groups (the results were RR=0.82,95%CI (0.67,1.01); RR=0.82,95%CI (0.67,1.01); RR=0.87,95%CI (0.58,1.31); RR=1.12,95%CI (0.66,1.92); RR=0.58,95%CI (0.14,2.35); RR=1.21,95%CI (0.69,2.14)).
2. Amikacin combined with Pseudomonas sp. B- lactam drugs VS quinolone antibiotics combined with Pseudomonas beta lactam: Amikacin combined with Pseudomonas beta lactam for the empirical treatment of HAP, the bacterial clearance rate is superior to quinolone antibiotics combined with Pseudomonas beta lactam drugs, Statistical significance [RR=1.34,95%CI (1.07,1.67)]; there were no statistical differences in the two groups of Pseudomonas aeruginosa clearance rate, double infection rate and mortality rate (RR=1.13,95%CI (0.74,1.73), RR=1.05,95%CI (0.24,4.59), RR=0.88,95%CI (0.55,1.43)).
3. Amikacin combined cefepime VS cefepime single use: the clinical efficacy of HAP combined with cefepime in combination with cefepime, the bacterial clearance rate is better than cefepime alone, with statistical differences (RR=1.25,95%CI (1.09,1.45) and RR=l.32,95%CI (1.09,1.59), respectively, and the failure rate is lower than cefepime alone. [RR=0.38,95%CI (0.20,0.72)); there were no statistical differences in the two groups of Pseudomonas aeruginosa clearance rate, double infection rate and mortality rate (RR=1.29,95%CI (0.9,1.72); RR=3.16,95%CI (0.36,27.78); RR=1.85,95%CI (0.37,9.18)).
Conclusion:
The systematic evaluation showed the effectiveness and safety of Amikacin combined with p- lactam drug for the treatment of HAP. The evidence supported by the drug was low in quality and weak recommendation. The number of studies included is small, the sample size is small, and most of the research methodology is not high, and more high quality and large-scale RCT is needed. When the evidence is applied, the evidence is applied. Be careful.
【學(xué)位授予單位】：湖南師范大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R96;R563.1

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