摘要
目的系统评价抗生素降阶梯方案治疗重症肺炎患者的有效性与安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、CNKI、VIP和WanFang Data数据库,同时检索中国临床试验注册中心(www.chictr.org.cn),搜集关于抗生素降阶梯方案治疗重症肺炎患者的随机对照试验(RCT),检索时限均从建库至2017年6月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入13个RCT,包括1 860例患者。Meta分析结果显示:与对照组相比,抗生素降阶梯组的临床治愈率明显更高[RR=1.28,95%CI(1.20,1.35),P<0.000 01],总住院时间[MD=–6.74,95%CI(–8.65,–4.82),P<0.000 01]、并发症控制时间[MD=–6.86,95%CI(–9.12,–4.59),P<0.000 01]明显缩短,病死率明显降低[RR=0.48,95%CI(0.28,0.82),P=0.008]。纳入研究报道的不良反应较少,且程度均为轻、中度,安全性尚可。结论当前证据表明,抗生素降阶梯治疗方案在重症肺炎患者治疗过程中相比常规治疗疗效更佳,能够显著缩短总住院时间、降低病死率。受纳入研究质量和数量限制,上述结论尚待更多高质量研究予以验证。
Objectives To systematically review the efficacy and safety of de-escalation therapy for severe pneumonia. Methods We searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases and the Chinese Clinical Trial Registry （www.chictr.org.cn） to collect randomized controlled trials （RCTs） of de-escalation therapy for patients with severe pneumonia from inception to June, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 13 RCTs involving 1 860 patients were included. The results of meta- analysis showed that： the de-escalation therapy group was superior to the control group on clinical cure rate （RR=1.28, 95%CI 1.20 to 1.35, P〈0.000 01）, the total hospitalization time （MD=-6.86, 95%CI -9.12 to -4.59, P〈0.000 01）, remission time of complications （MD=-6.26, 95%CI -8.43 to -4.10, P〈0.000 01） and mortality （RR=0.48, 95%CI 0.28 to 0.82, P=0.001）. Reported cases of adverse reactions were rare, in which the degree of reactions ranged from mild to moderate. The safety was fairly satisfactory. Conclusions Current evidence shows that de-escalation therapy for patients with severe pneumonia has improved efficacy compared with conventional treatments, and can significantly shorten the total hospitalization time and reduce mortality. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
出处
《中国循证医学杂志》
CSCD
北大核心
2018年第1期52-58,共7页
Chinese Journal of Evidence-based Medicine
基金
中国药学会医院处方分析合作项目(编号:312120242)
关键词
降阶梯治疗
抗生素
重症肺炎
系统评价
META分析
随机对照试验
De-escalation therapy
Antibiotic
Severe pneumonia
Systematic review
Meta-analysis
Randomized controlled trial
