本文選題：導(dǎo)尿管　切入點(diǎn)：尿路感染　出處：《中南大學(xué)》2014年碩士論文

【摘要】：目的系統(tǒng)評(píng)價(jià)預(yù)防使用抗菌藥是否能降低導(dǎo)尿管相關(guān)性尿路感染的發(fā)生。 方法對(duì)PUBMED、Cochrane library、Wiley Online Library、相關(guān)期刊論文(CNKI)和萬(wàn)方數(shù)字化期刊全文數(shù)據(jù)庫(kù)的檢索,檢出發(fā)表于1980年1月-2014年3月期間的關(guān)于抗菌藥預(yù)防導(dǎo)尿管相關(guān)性尿路感染的隨機(jī)對(duì)照試驗(yàn),再根據(jù)納入標(biāo)準(zhǔn)(住院患者在留置導(dǎo)尿管前、留置導(dǎo)尿管期間或?qū)蚬馨纬箢A(yù)防性全身使用抗菌藥)和排除標(biāo)準(zhǔn)對(duì)入選文獻(xiàn)進(jìn)行方法學(xué)質(zhì)量評(píng)價(jià)、資料提取后,數(shù)據(jù)用RevMan5.2軟件和R軟件R2WinBUGS程序包進(jìn)行Meta分析,并采用GRADE系統(tǒng)評(píng)價(jià)證據(jù)質(zhì)量和推薦等級(jí)。 結(jié)果根據(jù)納入標(biāo)準(zhǔn),最終納入13個(gè)英文文獻(xiàn),通過(guò)Meta分析結(jié)果顯示：與對(duì)照組比較,抗菌藥組能降低拔除導(dǎo)尿管48h內(nèi)菌尿癥發(fā)生率(OR值0.14,95%CI[0.05,0.43],P=0.0005),降低預(yù)防用藥后7d內(nèi)菌尿癥發(fā)生率(OR值0.21,95%CI[0.10,0.45],P0.0001),降低單劑量干預(yù)后出現(xiàn)的菌尿癥發(fā)生率(OR值0.4,95%CI[0.28,0.58],P0.00001),降低預(yù)防用藥后膿尿發(fā)生率(OR值0.22,95%CI[0.13,0.38],P0.00001),降低預(yù)防用藥后尿培養(yǎng)陽(yáng)性發(fā)生率(OR值0.36,95%CI[0.20,0.66],P=0.0009)。兩組的不良反應(yīng)發(fā)生和單劑量干預(yù)后出現(xiàn)細(xì)菌耐藥方面無(wú)顯著性差異。環(huán)丙沙星、左氧氟沙星和復(fù)方新諾明在預(yù)防菌尿癥發(fā)生無(wú)顯著性差異。 結(jié)論對(duì)于術(shù)前無(wú)尿路感染的易感人群(如糖尿病患者、免疫缺陷患者等),圍手術(shù)期后短期內(nèi)留置導(dǎo)尿管的患者,預(yù)防使用單劑量抗菌藥(拔除導(dǎo)尿管前或拔除后48h內(nèi))可有效減少繼發(fā)性尿路感染,且不良反應(yīng)和細(xì)菌耐藥性并未增加。
[Abstract]:Objective to systematically evaluate whether the prevention of antibiotic use can reduce urinary tract infection related to urinary tract.
The method of PUBMED, Cochrane library, Wiley Online Library, China Journal Full-text Database (CNKI) and Wanfang digital periodical full-text database, was published in January 1980 -2014 in March on the guide of randomized controlled trials of antibiotics to prevent catheter associated urinary tract infection, according to the inclusion criteria (in hospitalized patients with indwelling catheter before and during catheter or catheter after removal of prophylactic systemic use of antibacterial drugs) and exclusion criteria of the selected documents for methodological quality assessment, data extraction, data analysis was performed using Meta RevMan5.2 software and R R2WinBUGS software package, and the use of GRADE system to assess the quality of evidence and strength of recommendation.
Results according to the inclusion criteria, a total of 13 English literature, through the Meta analysis results showed that: compared with the control group, antibiotic group can reduce the removal of the catheter in 48h bacteriuria incidence (OR = 0.14,95%CI[0.05,0.43], P=0.0005), reduce the preventive medication within 7d after bacteriuria incidence (OR = 0.21,95%CI[0.10,0.45], P0.0001), reduced single dose intervention of bacteriuria incidence (OR = 0.4,95%CI[0.28,0.58], P0.00001), reduce the incidence of pyuria after preventive treatment (OR = 0.22,95%CI[0.13,0.38], P0.00001), decreased after preventive treatment of urine culture positive rate (OR = 0.36,95%CI[0.20,0.66], P=0.0009). The adverse reactions of the two groups and single dose dry the prognosis of bacterial resistance appeared no significant difference. Ciprofloxacin, levofloxacin and cotrimoxazole in prevention of bacteriuria were no significant difference.
Conclusion for the susceptibility to urinary tract infection without preoperative population (such as diabetes, immunodeficiency patients), the patients with indwelling catheter in the short term after the perioperative period, to prevent the use of antibiotics in a single dose (removal of the catheter before or after removal of 48h) can effectively reduce the secondary urinary tract infections, and the adverse reaction and bacterial resistance did not increase.

【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R691.3

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本文編號(hào)：1711399