银合金导尿管与标准导尿管预防尿路感染的荟萃分析

Comparison of silver alloy catheter with standard catheter in preventing urinary tract infection： a meta-analysis

目的 荟萃分析银合金导尿管预防尿路感染的效果,为临床实践与研究提供参考.方法 计算机检索Cochrane Library、PubMed、EMbase、中国生物医学文献数据库、中国学术期刊网络出版总库、维普资讯中文科技期刊数据库和万方数据知识服务平台,检索时限均从建库起至2012年11月16日,同时辅以其他检索,如对相关文献的参考文献进行追溯查找.收集所有银合金导尿管与标准导尿管（包括乳胶导尿管、硅胶导尿管、硅化乳胶导尿管、硅化橡胶导尿管、聚四氟乙烯涂层导尿管）比较预防短期留置导尿（＜30 d）患者尿路感染的随机对照试验（randomized controlled trial,RCT）.按照纳入标准选择文献、提取资料和评价纳入研究的方法学质量后,采用RevMan5.1软件进行荟萃分析,统计试验组与对照组疗效的比值比（DR）及95％CI. 结果 共纳入13个RCT 6 634例患者.荟萃分析结果显示：银合金导尿管组无症状菌尿的发生率低于乳胶导尿管组[OR=0.30,95％CI（0.23,0.40）,P=0.00]、硅胶导尿管组[OR=0.68,95％CI（0.51,0.91）,P=0.01]和普通导尿管组[OR=0.17,95％CI（0.09,0.31）,P=0.00],差异均有统计学意义.银合金导尿管组有症状尿路感染的发生率与聚四氟乙烯导尿管组比较差异无统计学意义[OR=0.99,95％ CI（0.83,1.19）,P=0.92].银合金导尿管组患者尿道不适感的发生率与标准导尿管组比较差异有统计学意义[OR=0.82,95％CI（0.70,0.95）,P=0.01],而疼痛的发生率差异无统计学意义[OR=0.72,95％CI（0.30,1.75）,P=0.47]. 结论 银合金导尿管与标准导尿管相比并不能降低有症状尿路感染的发生率,但银合金导尿管在降低无症状菌尿的发生率及提高患者舒适度方面优于标准导尿管.

Objective To evaluate the clinical effect of silver alloy catheter in preventing the urinary tract infection by meta-analysis.Methods The following databases,including Cochrane Library,PubMed,Embase,China Biology Medicine,China National Knowledge Infrastructure,VIP Information Chinese Science and Wanfang Data Knowledge Service Platform,were searched from the time of those database set to November 16,2012.And the other sources,such as tracing related references,were also retrieved.All randomized controlled trials （RCTs）,concerning silver alloy catheter versus standard catheter （including latex catheter,silicone catheter,silicon latex catheters,silicon rubber catheter,poly tetra fluoro ethylene （PTFE） coated catheter）,were collected to evaluate the incidence of urinary tract infection during shortterm catheterization （＜30 d）.The literatures were screened according to selection criteria.Data extraction and study quality evaluation were independently reviewed.Then the meta-analysis was conducted by using RevMan 5.1 software,and the odds ratio （OR） and 95％CI were calculated in both the study group （silver alloy catheter group） and control group （standard catheter group）.Results A total of 13 RCTs,and 6 634 patients were included.Meta-analysis results showed that the incidence of asymptomatic bacteriuria in silver alloy catheter group was significantly less than latex catheter group [OR =0.30,95％CI （0.23,0.40）,P=0.00],silicone catheter group [OR =0.68,95％CI （0.51,0.91）,P=0.01],and ordinary catheter group（silicon latex / silicon rubber catheter） [OR =0.17,95％ CI （0.09,0.31）,P =0.00].There was no significant difference in the occurrence of symptomatic urinary tract infection between silver alloy catheter group and PTFE catheter group [OR=0.99,95％CI （0.83,1.19）,P=0.92].Comparing with the standard catheter group,a significant difference in the occurrence of urethral discomfort could be noticed in the silver alloy catheter group [OR =0.82,95％ CI （0.70,0.95）,P =0.01].However,the signicant difference did not appeare in the occurrence of pain between those 2 groups [OR=0.72,95％CI （0.30,1.75）,P=0.47].Conclusions Compared with the standard catheter,silver alloy catheter cannot reduce the incidence of symptomatic urinary tract infection.But silver alloy catheter is superior to standard catheter in reducing the occurrence of asymptomatic bacteriuria and increasing the comfort level of patient.