选择性消化道去污染预防呼吸机相关性肺炎的Meta分析

Selective decontamination of digestive tract for preventing ventilatorassociated pneumonia:a Meta-analysis

目的运用循证医学理论和方法,对选择性消化道去污染(SDD)预防呼吸机相关性肺炎(VAP)的效果进行Meta分析。方法计算机检索1995—2014年PubMed、EMBASE、中国生物医学文献数据库CBMdisc、中国学术期刊全文数据库CNKI、维普中文生物医学期刊数据库,以及Cochrane library(2014年第12期)共6个医学数据库,筛选文献,进行数据资料提取及质量评价,应用RevMan 5.3软件进行统计分析。结果共纳入13篇文献(包含2 676例患者),Meta分析结果显示,治疗组和对照组VAP发病率分别为20.68%、35.99%,OR及95%CI为0.40(0.28,0.56),两组比较差异有统计学意义(P<0.001);治疗组和对照组机械通气患者病死率分别为20.60%、20.03%,OR及95%CI为0.99(0.81,1.20),两组比较差异无统计学意义(P=0.91)。结论 SDD能降低机械通气患者VAP发病率,但尚不能认为SDD能降低机械通气患者病死率。

Objective To evaluate the effect of selective decontamination of digestive tract（SDD）on preventing ventilator-associated pneumonia by Meta-analysis based on theory and method of evidence-based medicine.Methods Six medical databases （PubMed,Excerpta Medica Database [EMBASE],China Biology Medicine disc[CBMdi-sc],China National Knowledge Infrastructure[CNKI],VIP database,from 1995 to 2014,and Cochrane Library of issue 12,2014 ）were searched,literatures were selected,data were extracted,Meta-analysis was performed by using RevMan 5.3 software.Results 13 literatures were included （2 676 patients were involved）,Meta-analysis revealed that the incidence of VAP in treatment and control group was 20.68% and 35.99% respectively （OR and 95%CI ,0.40 [0.28,0.56],P 〈0.001 ）,the mortality rate of patients with mechanical ventilation in treatment group and control group were 20.60% and 20.03% respectively （OR and 95%CI ,0.99 [0.81 ,1 .20],P =0.91 ）. Conclusion SDD can reduce the incidence of VAP in patients with mechanical ventilation,but can’t reduce mortality rate.