本文選題：降鈣素原 + 膿毒癥　； 參考：《中國(guó)現(xiàn)代醫(yī)學(xué)雜志》2016年09期

【摘要】：目的評(píng)價(jià)降鈣素原(PCT)指導(dǎo)抗生素策略在膿毒癥患者中應(yīng)用的有效性,為臨床決策提供參考依據(jù)。方法計(jì)算機(jī)檢索Pub Med、EMbase、the Cochrane Library、Web of Science、CBMdisc、CNKI和萬方數(shù)據(jù)庫(kù),收集關(guān)于PCT指導(dǎo)抗生素治療膿毒癥患者有效性的臨床隨機(jī)對(duì)照試驗(yàn)(RCT),檢索時(shí)間從建庫(kù)至2015年3月。由2位研究者按納入標(biāo)準(zhǔn)獨(dú)立篩選文獻(xiàn)、提取資料并評(píng)價(jià)質(zhì)量后,采用Rev Man 5.3軟件進(jìn)行Meta分析。結(jié)果納入10個(gè)RCT,共1 620例患者。Meta分析結(jié)果提示,與常規(guī)治療組比較,PCT指導(dǎo)組能夠縮短抗生素使用時(shí)間和總住院時(shí)間[MD_1=-1.41,(95%CI_1:-2.15,-0.68),P_1=0.000;MD_2=-2.98,(95%CI_2:-4.92,-1.05),P_2=0.002],而在院內(nèi)病死率、28 d病死率和ICU住院時(shí)間方面比較,差異無統(tǒng)計(jì)學(xué)意義[RR1=0.98,(95%CI1:0.72,1.33),P_1=0.090;RR_2=1.03,(95%CI_2:0.85,1.24),P_2=0.770;MD_3=-0.01,(95%CI_3:-0.27,0.25),P_3=0.930]。結(jié)論 PCT指導(dǎo)抗生素策略能夠縮短膿毒癥患者的抗生素使用時(shí)間和總住院時(shí)間,而對(duì)院內(nèi)病死率和28 d死亡率無明顯影響。但尚需大樣本、高質(zhì)量的RCT驗(yàn)證。
[Abstract]:Objective to evaluate the effectiveness of the application of procalcitonin (PCT)-guided antibiotic strategy in patients with sepsis and to provide reference for clinical decision-making. Methods the Pub Medbase of Cochrane Library Pub and Wanfang database were searched, and the clinical randomized controlled trials on the effectiveness of PCT in the treatment of sepsis were collected. The retrieval time was from the establishment of the database to March 2015. According to the inclusion criteria, two researchers independently sifted the literature, extracted the data and evaluated the quality, and then analyzed the data with Rev Man 5.3 software. Results A meta-analysis of 1 620 patients with 10 RCTs showed that compared with the routine treatment group, the PCT-guided group was able to shorten the antibiotic use time and total hospitalization time [MD1 / 1. 41 1 + 95 CI95: 1: -2.15 + -0. 68% P 1: 1 0. 000 and MD2- 2. 98 95 CI2: 4.92% -1 05% -1 05% P5 + 20.002], while the mortality rate of 28 days in the hospital and the length of ICU stay in hospital were higher than those in the PCT steering group (P < 0. 002), and compared with that in the normal treatment group (P < 0. 05), but the mortality rate in the hospital was 28 days compared with that in the control group (P < 0. 002), and the mortality rate in the hospital was 28 days. There was no statistical difference [RR1 / 0.988 / 95CI1: 0.72C / 1.33 / R10.090 / RR21.03C / 95CI95: 0: 2: 0.851.24C P 20.7700.70 MD3U -0.01 + 95C + 95]. [RR1: 0. 090 / RR1: 0. 090 / RR1: 0. 078 / 95CI3: 0. 27 0.27 0.25 in CI3 / 0. 30.) Conclusion the antibiotic strategy guided by PCT can shorten the antibiotic use time and total hospitalization time of sepsis patients, but has no significant effect on hospital mortality and 28 days mortality. But still need large sample, high quality RCT verification.
【作者單位】： 江蘇省常州市第四人民醫(yī)院急診科;
【分類號(hào)】：R459.7

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