雾化吸入阿米卡星联合静脉使用抗生素治疗呼吸机相关性肺炎有效性与安全性的meta分析

目的采用荟萃分析方法对国内外已发表的文献进行综合分析,评价雾化吸入阿米卡星对呼吸机相关性肺炎治疗的有效性及安全性。方法全面检索PubMed、Embase、Cochrane Central Register of Controlled Trials、Web of Science数据库、中国知网、维普及万方数据库,获取数据检索时间限定为从建库至2018年11月,对比雾化吸入阿米卡星联合静脉抗生素治疗与单用静脉抗生素治疗的随机对照研究(RCTs),依照系统评价和荟萃分析优先报告的条目进行文献筛选、数据提取以及质量评价,采用Revman 5.3软件进行荟萃分析。结果共有8篇RCTs纳入研究。荟萃分析结果显示:与单用静脉抗生素治疗相比,雾化吸入阿米卡星联合静脉抗生素治疗显著提高临床治愈率(OR=2.59,95%CI:1.87~3.59,P<0.00001),增加细菌清除率(OR=2.87,95%CI:1.93~4.27,P<0.00001),雾化联合治疗组撤机率(OR=1.88,95%CI:1.16~3.04,P=0.01)。但雾化吸入阿米卡星联合静脉抗生素和单纯抗生素治疗2组的病死率差异无统计学意义(OR=1.39,95%CI:0.86~2.24,P=0.18),支气管痉挛发生率(OR=2.30,95%CI:1.00~5.30,P=0.05)、肾功能损伤率(OR=0.61,95%CI:0.34~1.11,P=0.10)差异无统计学意义。结论呼吸机相关性肺炎患者予以雾化吸入阿米卡星联合静脉抗生素较单用静脉抗生素能改善患者临床治愈率、细菌清除率及呼吸机撤机率,但不会降低患者病死率及增加支气管痉挛发生率和肾功能损伤率。

Efficacy and safety of intravenous antibiotics combined with inhalation of amikacin versus intravenous antibiotics for treatment of ventilator-associated pneumonia:a systematic review and meta-analysis

Objective Reviewing and integrating published literature at home and abroad by meta-analysis to compare the efficacy and safety of aerosolized amikacin for treatment of ventilator-associated pneumonia(VAP).Methods Comprehensive searches were performed from the PubMed,Embase,Cochrane Central Register of Controlled Trials,Web of Science,VIP,China national knowledge internet and Wanfang database to acquire randomized controlled trials(RCTs)comparing intravenous antibiotics combined with inhalation of amikacin treatment with intravenous antibiotics and the data were collected from the time of establishment of databases to November 2018.The methodological quality of the included studies were assessed following the preferred reporting items for systematic reviews and meta-analysis guidelines.Statistical analysis on the data was performed by RevMan 5.3 software.Results Totally eight RCTs were included in the meta-analysis.Pooled analysis showed that compared to the intravenous antibiotics,intravenous antibiotics combined with inhalation of amikacin treatment significantly improved the clinical cure rate(OR=2.59,95%CI:1.87-3.59,P<0.00001),bacterial clearance rate(OR=2.87,95%CI:1.93-4.27,P<0.00001),and weaning rate(OR=1.88,95%CI:1.16-3.04,P=0.01).The death rate(OR=1.39,95%CI:0.86-2.24,P=0.18),the happening of bronchospasm(OR=2.30,95%CI:1.00-5.30,P=0.05)and renal dysfunction rate(OR=0.61,95%CI:0.34-1.11,P=0.10)were not significantly different for intravenous antibiotics combined with inhalation of amikacin versus intravenous antibiotics.Conclusions Patients with VAP received higher rate of clinical cure rate,bacterial clearance rate,and weaning rate and by using intravenous antibiotics combined with inhalation of amikacin treatment,whereas could not reduce the rate of mortality and didn′t increase the happening of bronchospasm and renal dysfunction rate.