初始治疗给药时机对呼吸机相关性肺炎的影响荟萃分析

Effect of timing of initial antibiotic therapy on ventilator-associated pneumonia:a meta-analysis

目的系统评价初始抗菌药物治疗的时机对呼吸机相关性肺炎（VAP）预后的影响,以改善患者预后。方法应用计算机检索PubMed、EMBASE、Cochrane library、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、万方数据库1995-2013年国内外发表的相关文献,对符合标准的文献采用Revoew Manager 5.2软件进行荟萃分析。结果共纳入文献4篇,共313例患者,其中干预组（早期经验性抗感染治疗组）158例,对照组（延迟针对性抗感染治疗组）155例,荟萃分析结果显示,干预组与对照组相比,在降低VAP病死率差异有统计学意义（RR=0.52,95%CI0.39~0.70,P〈0.01）,但机械通气天数差异无统计学意义。结论早期经验性抗菌药物治疗能显著降低VAP的病死率,而对机械通气天数并无显著影响。

OBJECTIVE To systematically evaluate the impact of the timing of initial antibiotic therapy on the prognosis of patients with ventilator-associated pneumonia（VAP）so as to improve the prognosis of the patients.METHODS The relevant literatures that were published in China and abroad in 1995-2013 were retrieved from the databases including PubMed,EMBASE,Cochrane library,CBM,CNKI,and Wanfang by using computer.The meta-analysis was performed for the eligible literatures with the use of Revoew Manager5.2software.RESULTS A total of 4pieces of literature were included in the study,with 313 patients involved,including the intervention group（early empirical antibiotic therapy group）with 158 cases and the control group（delay definitive antibiotic therapy group）with 155 cases.The results of the meta-analysis indicated that there was statistically significant difference in the reduction of mortality rate of VAP between the intervention group and the control group（RR=0.52,95%CI0.39-0.70,P〈0.01）,however,there was no statistically significant difference in the mechanical ventilation duration.CONCLUSION The early empirical antibiotic therapy can significantly reduce the mortality rate of VAP but does not have significant effect on the mechanical ventilation duration.