目的:通过查阅预防性使用万古霉素粉末手术比较的文献,对该方法在脊柱手术后降低感染率的效果做出系统评价,为以后的临床工作提供依据。方法:通过Pubmed,Medline,Elseveir,万方,CNKI等数据库,以“vancomycin”,“local/intraoperative/t...目的:通过查阅预防性使用万古霉素粉末手术比较的文献,对该方法在脊柱手术后降低感染率的效果做出系统评价,为以后的临床工作提供依据。方法:通过Pubmed,Medline,Elseveir,万方,CNKI等数据库,以“vancomycin”,“local/intraoperative/topical/intra-wound”,“spine/spinal/lumbar/cervical/thoracolumbar surgery”,“infection”,“SSI”,“脊柱”,“腰椎”,“颈椎”,“手术”,“万古霉素”,“感染”等关键词查找相关术中预防性应用万古霉素粉末对术后感染发生率影响方面的病例对照研究论文,并利用Revman5.3荟萃分析软件比较文献中总体感染率,并按不同亚组分析是否应用万古霉素对不同部位、不同类型的脊柱手术的感染率的影响。结果:共查出论文1713篇,其中病例对照试验有38篇,最后筛选出符合要求的文献25篇;有25个研究比较了预防性使用万古霉素粉末对脊柱手术后感染率的影响。总病例16,688例,其中预防性使用万古霉素组7048例,对照组9640例。其荟萃分析结果提示术中预防性使用万古霉素粉末后术后出现感染的可能性为不使用万古霉素时的0.38倍,二者之间的差异有显著性(P Objective: To systematically evaluate the effect of this method in reducing the infection rate after spinal surgery by reviewing the comparative literature of prophylactic vancomycin powder surgery, so as to provide a basis for future clinical work. Methods: Pubmed, Medline, Elseveir, Wanfang, CNKI and other databases, with the following methods: “vancomycin”, “local/intraoperative/topical/intra-wound”, “spine/spinal/lumbar/cervical/thoracolumbar surgery”, “infection”, “SSI”, “spine”, “lumbar spine”, “cervical spine”, “surgery”, “vancomycin”, “infection” and other keywords were used to find case-control research papers on the effect of intraoperative prophylactic vancomycin powder on the incidence of postoperative infection, and the Revman5.3 meta-analysis software was used to compare the overall infection rate in the literature, and the effect of vancomycin application on the infection rate of different parts and different types of spine surgery was analyzed according to different subgroups. Results: A total of 1713 papers were identified, including 38 case-control trials, and 25 papers were screened to meet the requirements. Twenty-five studies compared the effect of prophylactic use of vancomycin powder on infection rates after spinal surgery. The total number of cases was 16,688, including 7048 cases in the prophylactic vancomycin group and 9640 cases in the control group. The results of meta-analysis showed that the probability of postoperative infection after intraoperative prophylactic use of vancomycin powder was 0.38 times higher than that of vancomycin without vancomycin, and the difference between the two was significant (P < 0.01). At the same time, the incidence of infection after vancomycin was 0.28 times higher (0.17, 0.45) than that of vancomycin in patients treated with internal fixation (P < 0.01). However, vancomycin utilization in patients without internal fixation had no significant effect on postoperative infection (P = 0.61). Conclusion: The local prophylactic use of vancomycin powder in spine surgery can significantly reduce the incidence of postoperative infection, and this effect is more obvious in patients with internal fixation, which can be popularized and applied in clinical practice of spine surgery.展开更多
目的:研究万古霉素在模型引导下精准化给药是否可以达到更佳的临床治疗效果,从而推动其在实践中广泛应用。方法:采用前瞻性队列研究,试验组为使用模型引导下的精准化给药决策万古霉素给药方案的患者,对照组为仅依据现有诊疗流程决策万...目的:研究万古霉素在模型引导下精准化给药是否可以达到更佳的临床治疗效果,从而推动其在实践中广泛应用。方法:采用前瞻性队列研究,试验组为使用模型引导下的精准化给药决策万古霉素给药方案的患者,对照组为仅依据现有诊疗流程决策万古霉素给药方案的患者。匹配两组数据,对比两组患者在治疗药物监测(therapeutic drug monitoring,TDM)稳态谷浓度或稳态AUC达标比例上是否存在统计学差异,评估模型软件的应用价值。结果:根据纳入和排除标准,共计280例患者的万古霉素稳态血药浓度数据用于分析。试验最终得到,试验组达标人数10例,达标率为62.50%;对照组达标人数64例,达标率为24.24%(P=0.002)。结论:模型引导下精准化给药方案能更精准地控制患者体内万古霉素血药浓度,显著提高患者稳态谷浓度达标率。因此,建议加大对该方案的研究力度,并推动其在临床实践中广泛应用。展开更多
文摘目的:通过查阅预防性使用万古霉素粉末手术比较的文献,对该方法在脊柱手术后降低感染率的效果做出系统评价,为以后的临床工作提供依据。方法:通过Pubmed,Medline,Elseveir,万方,CNKI等数据库,以“vancomycin”,“local/intraoperative/topical/intra-wound”,“spine/spinal/lumbar/cervical/thoracolumbar surgery”,“infection”,“SSI”,“脊柱”,“腰椎”,“颈椎”,“手术”,“万古霉素”,“感染”等关键词查找相关术中预防性应用万古霉素粉末对术后感染发生率影响方面的病例对照研究论文,并利用Revman5.3荟萃分析软件比较文献中总体感染率,并按不同亚组分析是否应用万古霉素对不同部位、不同类型的脊柱手术的感染率的影响。结果:共查出论文1713篇,其中病例对照试验有38篇,最后筛选出符合要求的文献25篇;有25个研究比较了预防性使用万古霉素粉末对脊柱手术后感染率的影响。总病例16,688例,其中预防性使用万古霉素组7048例,对照组9640例。其荟萃分析结果提示术中预防性使用万古霉素粉末后术后出现感染的可能性为不使用万古霉素时的0.38倍,二者之间的差异有显著性(P Objective: To systematically evaluate the effect of this method in reducing the infection rate after spinal surgery by reviewing the comparative literature of prophylactic vancomycin powder surgery, so as to provide a basis for future clinical work. Methods: Pubmed, Medline, Elseveir, Wanfang, CNKI and other databases, with the following methods: “vancomycin”, “local/intraoperative/topical/intra-wound”, “spine/spinal/lumbar/cervical/thoracolumbar surgery”, “infection”, “SSI”, “spine”, “lumbar spine”, “cervical spine”, “surgery”, “vancomycin”, “infection” and other keywords were used to find case-control research papers on the effect of intraoperative prophylactic vancomycin powder on the incidence of postoperative infection, and the Revman5.3 meta-analysis software was used to compare the overall infection rate in the literature, and the effect of vancomycin application on the infection rate of different parts and different types of spine surgery was analyzed according to different subgroups. Results: A total of 1713 papers were identified, including 38 case-control trials, and 25 papers were screened to meet the requirements. Twenty-five studies compared the effect of prophylactic use of vancomycin powder on infection rates after spinal surgery. The total number of cases was 16,688, including 7048 cases in the prophylactic vancomycin group and 9640 cases in the control group. The results of meta-analysis showed that the probability of postoperative infection after intraoperative prophylactic use of vancomycin powder was 0.38 times higher than that of vancomycin without vancomycin, and the difference between the two was significant (P < 0.01). At the same time, the incidence of infection after vancomycin was 0.28 times higher (0.17, 0.45) than that of vancomycin in patients treated with internal fixation (P < 0.01). However, vancomycin utilization in patients without internal fixation had no significant effect on postoperative infection (P = 0.61). Conclusion: The local prophylactic use of vancomycin powder in spine surgery can significantly reduce the incidence of postoperative infection, and this effect is more obvious in patients with internal fixation, which can be popularized and applied in clinical practice of spine surgery.
文摘目的:研究万古霉素在模型引导下精准化给药是否可以达到更佳的临床治疗效果,从而推动其在实践中广泛应用。方法:采用前瞻性队列研究,试验组为使用模型引导下的精准化给药决策万古霉素给药方案的患者,对照组为仅依据现有诊疗流程决策万古霉素给药方案的患者。匹配两组数据,对比两组患者在治疗药物监测(therapeutic drug monitoring,TDM)稳态谷浓度或稳态AUC达标比例上是否存在统计学差异,评估模型软件的应用价值。结果:根据纳入和排除标准,共计280例患者的万古霉素稳态血药浓度数据用于分析。试验最终得到,试验组达标人数10例,达标率为62.50%;对照组达标人数64例,达标率为24.24%(P=0.002)。结论:模型引导下精准化给药方案能更精准地控制患者体内万古霉素血药浓度,显著提高患者稳态谷浓度达标率。因此,建议加大对该方案的研究力度,并推动其在临床实践中广泛应用。
