Meta分析评价美罗培南不同输注方式对ICU脓毒血症患者的治疗效果

Effect of different infusion modes of meropenem on ICU patients with spesis: a meta-analysis

目的采用meta分析评价美罗培南不同输注方式对ICU脓毒血症患者的有效性与安全性。方法系统检索PubMed、Web of science、Embase、Cochrane图书馆、CNKI、VIP、WanFang、CBMdisc等数据库,收集美罗培南不同输注方式治疗ICU脓毒血症的系列研究,采用RevMan 5.3软件进行meta分析。结果共纳入8项临床研究,合计1219例患者。Meta分析结果显示,延长输注和持续输注组患者临床治疗有效率[OR=3.66,95%CI(2.74,4.90),P <0.000 01]、细菌清除率[OR=3.22,95%CI(2.38,4.34),P <0.000 01]、耐药菌发生率[OR=0.34,95%CI(0.20,0.56),P <0.0001]显著高于传统输注组;与传统输注组相比,延长输注和持续输注组患者治疗后体温[WMD=-0.93,95%CI(-1.41,-0.44),P=0.0002]、白细胞计数[WMD=-0.91,95%CI(-1.47,-0.36),P=0.001]、ICU平均住院时间[WMD=-6.28,95%CI(-7.38,-5.19),P <0.000 01]明显降低。安全性方面,美罗培南输注用药的不良反应报道较少,且延长输注和持续输注比传统输注不良反应更少,用药相对较为安全。结论与传统输注方式相比,延长或持续输注美罗培南可提高治疗ICU脓毒血症患者的疗效。受方法学的限制,该结论仍需更多大样本、高质量的随机对照试验进一步验证。

Objective To evaluate the therapeutic effect of meropenem by different infusion methods on ICU patients with sepsis by conducting a meta-analysis. Methods The trials of meropenem by different infusion methods in ICU patients with sepsis were gathered from PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, WanFang and CBMdisc Data. After data extraction and quality assessment of the included RCTs, RevMan 5.3 software was used for the meta-analysis. Results Eight studies were included, involving 1219 patients. The meta-analysis showed that effective rate [OR = 3.66, 95%CI(2.74, 4.90), P< 0.000 01], bacterial eradication rate [OR = 3.22, 95%CI(2.38, 4.34), P < 0.000 01] and incidence of resistant bacteria [OR = 0.34, 95%CI(0.20, 0.56), P < 0.0001] in the test groups were significantly higher than those in the control group. Compared with the control group, the body temperature [WMD =-0.93, 95%CI(-1.41,-0.44), P = 0.0002], white blood cell count [WMD =-0.91, 95%CI(-1.47,-0.36), P = 0.001], and length of stay in ICU [WMD =-6.28, 95%CI(-7.38,-5.19), P < 0.000 01] after the treatment in the test groups were significantly decreased. In terms of safety, the adverse reactions of meropenem infusion were seldom reported, and the prolonged infusion and continuous infusion had fewer adverse reactions than traditional infusion, so the drug was relatively safe. Conclusion Compared with the traditional infusion of meropenem, extended or continuous infusion can improve its efficacy in the treatment of severe infections, with similar safety. Due to methodology limit in the included studies, large-scale and high quality RCT are required for further validation.