单一及联合应用抗生素治疗呼吸机相关性肺炎效果Meta分析

Meta-analysis of the effect of antibiotic combination therapy vs monotherapy on ventilator-associated pneumonia

目的系统评价单一及联合使用抗生素治疗呼吸机相关性肺炎（ventilator-associated pneumonia,VAP）的效果。方法应用计算机检索PubMed、EMBASE、Cochrane library、中国生物医学文献数据库、中国期刊全文数据库、万方数据库1990年1月—2014年3月发表的相关文献,对符合标准的文献,由2名评价员应用Jadad量表评价文献质量,应用Revoew Manager5.2软件进行Meta分析。结果共纳入文献6篇,Jadad量表评分均高于4分,共1 190例患者,其中联合抗生素治疗组（联合组）624例,单一抗生素治疗组（对照组）566例;Meta分析结果显示,2组病死率（RR=0.98,95%CI：0.80~1.20,P=0.87）、治愈率（RR=1.11,95%CI：0.65~1.92,P=0.70）、ICU留治时间（MD=-0.72,95%CI：-5.23~3.78,P=0.75）、机械通气时间（MD=-0.37,95%CI：-4.15~3.42,P=0.85）差异无统计学意义。结论对VAP患者,推荐常规选用恰当抗菌谱的单一抗生素治疗。

Objective To evaluate the effect of antibiotic combination therapy vs monotherapy on ventilator-associated pneumonia（VAP）by a meta-analysis.Methods The relevant literatures from January 1990 to March 2014 were retrieved in the PubMed,EMBASE,Cochrane library,CBM and NKIMEDLINE.All articles were assessed the quality by two reviewers with Jadad.The meta-analysis was performed and the results of the trials were analyzed by the Revoew Manager 5.2software.Results In 6extracted articles with Jadad score 4,a total of 1 190 patients were included and were divided into combination therapy group（n=624）and monotherapy group（n=566）.Meta-analysis revealed there were no significant differences in the fatality of VAP（RR=0.98,95%CI：0.80 to 1.20,P=0.87）,the curative rate of VAP（RR=1.11,95%CI：0.65 to 1.92,P=0.70）,the ICU stay（MD=-0.72,95%CI：-5.23 to 3.78,P=0.75）and the duration of mechanical ventilation（MD=-0.37,95%CI：-4.15 to 3.42,P=0.85）between two groups.ConclusionIt is recommended for VAP to choose antibiotic monotherapy of appropriate antimicrobial spectrum.