氨溴索防治术后肺部并发症的疗效及安全性的直接和间接比较

Effi cacy and safety of ambroxol in the prevention and treatment for postoperative pulmonary complications

目的系统评价围手术期静脉用氨溴索防治术后肺部并发症的疗效及安全性。方法计算机检索Pubmed、Elsevier、Springer Link、Cochrane library及中国知网(CNKI)、维普资讯(VIP)和万方数据库,检索时限均为从建库至2014年4月,收集围手术期静脉用氨溴索防治术后肺部并发症的随机对照研究。由两位研究者按照纳入与排除标准,独立进行文献筛选、资料提取和评价纳入研究的方法学质量。采用Rev Man 5.2软件进行Meta分析。结果纳入15项研究的合并分析显示,氨溴索组与安慰剂组的术后肺部并发症、肺部感染及肺不张的发生率差异显著,RR(95%CI)分别为0.44(0.35,0.55),0.45(0.33,0.62),0.37(0.26,0.52)。氨溴索还能缩短术后抗生素使用时间[MD=-1.70,(-1.92,-1.47)]及住院时间[MD=-2.5,(-3.15,-1.85)]。间接比较显示,高剂量氨溴索组(一日>900 mg)的肺部并发症、肺不张的发生率并不低于中、低剂量组,差异无统计学意义。氨溴索的药物不良反应较轻。结论围手术期应用氨溴索的疗效及安全性较好,然而氨溴索的最佳用法用量仍有待确定。

Objective To evaluate the effi cacy and safety of ambroxol in the prevention and treatment for postoperative pulmonary complications. Methods Database as Pubmed, Elsevier, Springer Link, Cochrane library, CNKI, VIP and Wanfang Data were electronically searched from inception to April, 2014 on the topic of ambroxol clinical trials in the prevention and treatment of postoperative pulmonary complications. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Meta-analysis was performed by Rev Man 5.2. Results Fifteen eligible studies were included and the pooled results indicated that compared with placebo ambroxol reduced the incidences of postoperative pulmonary complications, lung infection and atelectasis. Their pooled RR（95%CI） were 0.44（0.35, 0.55）, 0.45（0.33, 0.62） and 0.37（0.26, 0.52） respectively. Besides, ambroxol reduced the treatment duration of postoperative antibiotics [MD=-1.70,（-1.92,-1.47）] and hospital stay [MD=-2.5,（-3.15,-1.85）]. Indirect comparison showed that incidence of postoperative pulmonary complications in high dose group was not lower than other groups, and differences across groups were not signifi cant. Conclusion Ambroxol is effective and safe in management of postoperative pulmonary complications.