头孢哌酮钠舒巴坦钠致凝血功能障碍危险因素的meta分析

Meta-analysis of risk factors for coagulation disorders caused by cefoperazone sodium and sulbactam sodium

目的系统性评价头孢哌酮钠舒巴坦钠致凝血功能障碍的危险因素,为临床合理用药提供参考。方法检索中英文数据库包括中国期刊全文数据库、中国生物医学文献数据库、维普资讯、万方数据知识服务平台、PubMed、Web of Science、Cochrane Library及Embase等数据库,检索时间自数据库建库至2023年1月31日,收集头孢哌酮钠舒巴坦钠致凝血功能障碍的危险因素相关文献,对符合纳入及排除标准的文献进行资料提取及质量评价后,采用RevMan 5.3软件进行meta分析。结果共纳入12项研究,全部为回顾性研究,涉及患者1621例。meta分析结果显示,禁食(OR=7.12,95%CI:4.59~11.06,P<0.00001)、血肌酐水平轻度升高(OR=1.04,95%CI:1.02~1.06,P=0.0002)、血肌酐水平重度升高(OR=4.15,95%CI:2.70~6.38,P<0.00001)、肝功能异常(OR=7.05,95%CI:3.83~12.98,P<0.00001)、用药疗程>9 d(OR=3.44,95%CI:2.16~5.48,P<0.00001)及用药剂量≥9 g/d(OR=3.26,95%CI:1.94~5.46,P<0.00001)、早产(OR=9.70,95%CI:3.59~26.19,P<0.00001)和营养不良(OR=4.21,95%CI:1.83~9.67,P=0.0007)与头孢哌酮钠舒巴坦钠致凝血功能障碍风险增加显著相关。各项研究漏斗图均基本对称,Begg's检验结果显示纳入文献不存在发表偏倚(P>0.05)。结论影响头孢哌酮钠舒巴坦钠致凝血功能障碍的危险因素包括禁食、肝肾功能异常、用药疗程和剂量过大、早产及营养不良。对于合并多个危险因素的患者,建议根据药敏试验结果选择对凝血功能影响较小的抗菌药物进行治疗。

Objective To systematically evaluate the risk factors for coagulation disorders caused by cefoperazone sodium and sulbactam sodium,and provide reference for clinical rational drug use.Methods The Chinese and English databases were searched,including CNKI,CBM,VIP,Wanfang Data,PubMed,Web of Science,Cochrane Library and Embase.The search was conducted from the establishment of the database to January 31,2023,and the literatures on risk factors related to coagulation disorders caused by cefoperazone sodium and sulbactam sodium were collected.After extracting data and assessing the quality of literature that met the inclusion and exclusion criteria,a meta-analysis was conducted using RevMan 5.3 software.Results Twelve retrospective analysis studies involving 1621 patients were eligible for meta-analysis.The results showed that fasting(OR=7.12,95%CI:4.59 to 11.06,P<0.00001),mildly elevated serum creatinine(OR=1.04,95%CI:1.02 to 1.06,P=0.0002),severely elevated serum creatinine(OR=4.15,95%CI:2.70 to 6.38,P<0.00001),liver dysfunction(OR=7.05,95%CI:3.83 to 12.98,P<0.00001),medication duration>9 d(OR=3.44,95%CI:2.16 to 5.48,P<0.00001),dosage≥9 g/d(OR=3.26,95%CI:1.94 to 5.46,P<0.00001),premature birth(OR=9.70,95%CI:3.59 to 26.19,P<0.00001)and malnutrition(OR=4.21,95%CI:1.83 to 9.67,P=0.0007)were the independent risk factors for coagulation disorders caused by cefoperazone sodium and sulbactam sodium.The funnel plots were essentially symmetrical,and Begg's test results showed no publication bias(P>0.05).Conclusion Risk factors influencing coagulation disorelers caused by cefoperazone sodium and sulbactam sodium include fasting,abnormalities in liver and kidney function,excessive medication duration and dose,prematurity,and malnutrition.For patients with multiple risk factors,it is recommended to select antibiotics with less effect on coagulation function by sensitivity test.