痰热清注射液辅助治疗呼吸机相关性肺炎的Meta分析

Meta-analysis of Tanreqing Injection in the Adjuvant Treatment of Ventilator-associated Pneumonia

目的观察痰热清注射液对呼吸机相关性肺炎(VAP)患者的临床疗效及预后情况的影响。方法检索PubMed、Embase、Cochrane、中国知网、万方、维普、中国生物医学文献数据库,纳入痰热清注射液治疗VAP的随机对照试验,以总有效率、抗生素使用时间、重症监护病房(ICU)住院时间、机械通气时间、脱机成功率、死亡率为结局指标,提取并合并数据。使用Cochrane协作网偏倚风险评估工具进行单个研究的质量评价,使用Revman5.3软件进行Meta分析。结果最终纳入22个RCT,共计1612例患者。Meta分析结果显示:痰热清组总有效率优于对照组[OR=4.12,95%CI(2.86,5.93),P<0.00001];可明显缩短ICU住院天数[MD-2.53,95%CI(-3.24,-1.82),P<0.00001]、抗生素使用时间[MD=-4.16,95%CI(-5.02,-3.30),P<0.00001];提高脱机成功率[OR=2.57,95%CI(1.45,4.56),P=0.001],降低死亡率[RR=0.27,95%CI(0.09,0.79),P=0.02]。结论痰热清注射液辅助治疗呼吸机相关性肺炎,可提高临床疗效并改善预后,但没有足够证据表明痰热清组能缩短机械通气时间。

Objective:To investigate the effect of Tanreqing Injection on the clinical efficacy and prognosis of ventilator-associated pneumonia(VAP)patients.Methods:PubMed,Embase,the Cochrane,CNKI,Wanfang,VIP and SinoMed databases were searched for random controlled trials(RCTs)of Tanreqing Injection in the treatment of VAP.The total effective rate,the time of using antibiotic,the duration of ICU stay,the time of mechanical ventilation,the success rate of off-line operation,and the mortality were used as outcome indexes.The data was then extracted and merged.The bias risk assessment tool of Cochrane collaborative network was used to evaluate the quality of a single study.Review Manager 5.3 software was used to conduct meta-analysis.Results:22 RCTs were included,1612 patients in total.Meta-analysis results showed that the total efficiency of the Tanreqing Injection group was significantly better than that of the control group[OR=4.12,95%CI(2.86,5.93),P<0.00001];Tanreqing Injection could shorten the duration of ICU stay[MD=-2.53,95%CI(-3.24,-1.82),P<0.00001]and the time of using antibiotic[MD=-4.16,95%CI(-5.02,-3.30),P<0.00001].It also had the higher success rate of offline operation[OR=2.57,95%CI(1.45,4.56),P=0.001]and the lower mortality[RR=0.27,95%CI(0.09,0.79),P=0.02].Conclusion:Combined with Tanreqing Injection in the treatment of VAP patients,the clinical effect and prognosis can be improved.However,there is insufficient evidence to show that Tanreqing Injection group can shorten the time of mechanical ventilation.