华西医学

华西医学

雾化吸入氨基糖苷类抗菌药物治疗呼吸机相关性肺炎的 meta 分析

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目的通过 meta 分析研究雾化吸入氨基糖苷类抗菌药物在呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者中的疗效。方法计算机检索 PubMed、Embase、中国知网、维普数据库和万方数据库,查找 2018 年 5 月前发表的有关雾化吸入氨基糖苷类抗菌药物治疗 VAP 的中英文文献,进行数据提取和质量评价后,应用 RevMan 5.2 软件进行 meta 分析。结果符合入选标准的共有 9 项随机对照试验,共计 543 例患者。meta 分析结果显示:与非雾化吸入氨基糖苷类抗菌药物治疗的患者相比,雾化吸入阿米卡星可显著提高 VAP 患者的临床治愈率[比值比(odds ratio,OR)=2.37,95% 置信区间(confidence interval,CI)=(1.50,3.75),P=0.000 2],雾化吸入妥布霉素[OR=2.30,95%CI(0.92,5.78),P=0.08]和 2 种及以上抗菌药物[OR=2.00,95%CI(0.62,6.46),P=0.25]对 VAP 患者的临床治愈率无显著影响;雾化吸入氨基糖苷类抗菌药物对 VAP 患者的病死率[OR=1.17,95%CI(0.66,2.07),P=0.59]、气管痉挛率[OR=2.39,95%CI(0.94,6.11),P=0.07]及肾功能损伤率[OR=0.62,95%CI(0.32,1.21),P=0.16]均无显著影响。结论雾化吸入阿米卡星可显著提高 VAP 患者的临床治愈率,但未能降低患者的病死率,雾化吸入氨基糖苷类抗菌药物安全性好,未增加 VAP 患者气管痉挛及肾功能损伤的发生风险。

ObjectiveTo evaluate the efficacy of aerosolized aminoglycoside antibiotics in patients with ventilator-associated pneumonia (VAP) by meta-analysis.MethodsWe searched PubMed, Embase, China National Knowledge Infrastructure, VIP and Wanfang Data for the Chinese and English literature on aerosolized aminoglycoside antibiotics for VAP until May, 2018. After data extraction and quality evaluation, RevMan 5.2 software was performed for meta-analysis.ResultsA total of 9 randomized controlled trials and a total of 543 patients were included in this study. Compared with patients treated with non-atomized inhaled aminoglycoside antibiotics, meta-analysis showed that aerosol inhalation of amikacin significantly improved the clinical cure rate of patients with VAP [odds ratio (OR)=2.37, 95% confidence interval (CI) (1.50, 3.75), P=0.000 2], nebulized tobramycin [OR=2.30, 95%CI (0.92, 5.78), P=0.08] and two or more antibiotics [OR=2.00, 95%CI (0.62, 6.46), P=0.25] had no significant effect on the clinical cure rate of patients with VAP; aerosolized aminoglycoside antibiotics had no significant effect on mortality of patients [OR=1.17, 95%CI (0.66, 2.07), P=0.59] and tracheal spasm rate [OR=2.39, 95%CI (0.94, 6.11), P=0.07] and renal dysfunction rate [OR=0.62, 95%CI (0.32, 1.21), P=0.16] in patients with VAP.ConclusionInhalation of amikacin can significantly improve the clinical cure rate of patients with VAP, but it can not reduce the mortality rate of patients; the safety of aerosolized aminoglycoside antibiotics is good, and the risk of tracheal spasm and renal function damage in patients with VAP is not increased.

关键词: 氨基糖苷类抗菌药物; 雾化吸入; 呼吸机相关性肺炎; Meta 分析

Key words: Aminoglycoside antibiotics; Aerosol inhalation; Ventilator-associated pneumonia; Meta-analysis

引用本文: 黄吉桢, 范红, 张永刚, 童翔. 雾化吸入氨基糖苷类抗菌药物治疗呼吸机相关性肺炎的 meta 分析. 华西医学, 2019, 34(1): 58-65. doi: 10.7507/1002-0179.201901048 复制

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