新医改前后我国儿童上呼吸道感染抗生素使用率的Meta分析

Meta-Analysis on Antibiotics Usage in Children with Upper Respiratory Tract Infection in China

目的采用Meta分析了解我国近16年来上呼吸道感染(以下简称上感)患儿抗生素使用率情况,从而评价新医改以来国家颁布的有关合理用药政策的有效性。方法检索中国期刊全文数据库(CNKI)、维普(VIP)、万方中有关中国儿童上呼吸道感染抗生素使用率的研究文献,在Pubmed、Ebsco、Web of Science、Embase中检索研究现场为中国大陆地区的外文文献并进行Meta分析,同时通过文献研究时间、地区和机构类别来进行对比研究。结果符合入选标准文献共32篇,总样本量54 189例。经Meta分析发现,我国儿童上感抗生素使用率合并值为89.2%(95%CI=82.22%~96.2%)。2009年前后儿童上感抗生素使用率分别为92.2%和87.6%;东部、中部和西部儿童上感抗生素使用率分别为88.3%、88.4%和93.3%;三级医院、二级医院及基层医疗机构(包括一级医院、社区卫生服务中心和乡镇卫生院)儿童上感抗生素使用率分别为85.2%、92.2%和90.2%。结论我国儿童上感抗生素使用率相对较高,且在不同时间、地区和医疗机构类别间使用率存在差别,医改政策颁布后其使用率下降,可能与政策实施有一定相关性。

OBJECTIVE To understand the condition of antibiotics usage in children with upper respiratory tract infection in Chi- na, so as to evaluate the effectiveness of rational drug use policy since the new health care reform promulgated by the state. METHODS Publications were extracted from China National Knowledge Infrastructure（ CNKI）, Chinese Science and Technolo- gy Journal Database （VIP）, Wanfang Databases, PubMed, Ebsco, Web of Science and Embase, then Meta-analysis was carried out on them, at the same time, do comparative study on times, regions and categories. RESULTS Thirty three papers were included for Meta-analysis with a total sample of 54 189. Meta-analysis showed that the combined rate of antibiotics usage in children with upper respiratory tract infection in China was 89. 2% （95% CI = 82. 2% - 96. 2%. Before 2009, the antibiotics use rate was 92. 2%, and it turned to be 87.6% after 2009. The antibiotics use rate of eastern,central and western children was 88. 3% ,88. 4% and 93.3%. Ter- tiary hospitals was 85.2% ,secondary hospitals was 92. 2% and primary medical institutions（including first level hospitals,community health service centers and township health centers） was 90. 2%. CONCLUSION Children＇s antibiotic use rate of upper upper respir- atory tract infection is high in China and the rate is different at different times, regions and institutions. After the health care reform pol- icy was enacted, the use rate of antibiotics fell, this may be related to the implementation of the policy.