摘要
目的:系统评价益生菌制剂用于预防呼吸机相关性肺炎(VAP)的有效性和安全性。方法:计算机检索PubMed、Web of Science、Cochrane图书馆、CNKI、CBM和万方等数据库,检索时限从建库至2012年12月,查找益生菌制剂用于预防呼吸机相关性肺炎的随机对照试验(RCT)。按照纳入排除标准选择文献、提取资料和评价纳入研究的方法学质量后,采用Cochrane协作网提供的RevMan 5.1.0软件进行Meta分析。结果:共纳入9个RCT,1 243例患者。Meta分析结果显示:预防性益生菌的使用并不能降低VAP的发生率[RR=0.82,95%CI(0.66,1.01),P=0.06],也不能显著改善以下的结局指标:ICU死亡率[RR=0.88,95%CI(0.64,1.21),P=0.42],住院死亡率[RR=0.78,95%CI(0.58,1.05),P=0.10],ICU住院时间[MD=0.61,95%CI(-2.89,4.01),P=0.73],医院住院时间[MD=-0.99,95%CI(-5.36,3.38),P=0.66],机械通气时间[MD=0.74,95%CI(-2.62,4.10),P=0.67],腹泻发生率[RR=0.91,95%CI(0.77,1.09),P=0.31]以及抗生素使用时间,但可以显著降低呼吸道绿脓杆菌定植率[RR=0.38,95%CI(0.15,0.94)P=0.04]。所有的RCT均无严重不良事件报道。结论:目前有限的证据表明预防用益生菌并不能降低机械通气患者VAP的发生率及死亡率。但鉴于研究设计间存在一定的异质性,以及ICU患者的特殊性,尚需大样本、高质量的随机对照试验来进一步验证。
OBJECtIVE To systematically assess the efficacy and safety of probiotics for prevention of ventilator-associated pneumonia. METHODS Randomized controlled trials （RCTs） of probiotics for prevention of ventilator-associated pneumonia compared with placebo or other treatment were searched in PubMed, Web of Science, the Cochrane Library, CNKI, CBM and WanFang Data published before December 2012. RCTs were selected according to the inclusion and exclusion criteria. The data were extracted, the methodological quality of the included studies was assessed, and the Meta-analysis was performed with Revman5.1. 0. RESULTS 9 RCTs on probiotics preventing ventilator-associated pneumonia（n = 1243） were identified. The Meta-analyses showed that probiotics didn＇t statistically decease the incidence of VAP[-RR = 0. 82,95%CI（0. 66, 1.01 ）, P = 0. 06] and other outcomes： ICU mortality[-RR = 0. 88,95% CI（0. 64,1.21 ）, P = 0. 42], hospital mortalityERR = 0. 78,95 % CI （0. 58,1.05）,P = 0. 10], ICU length of stayEMD = 0. 61,95%CI（ -2.89,4. 01）, P = 0. 73], hospital length of stay[-MD = - 0. 99,95% CI（ - 5.36,3.38）, P = 0. 66], duration of mechanical ventilation days [MD = 0. 74,95 % CI （ - 2.62,4. 10）, P = 0. 67], incidence of diarrhea[-RR = 0. 91,95 %CI（0. 77, 1.09）, P = 0. 31] and antibiotic-days. But the incidence of colonization of respiratory tract with Pseudomonas aeruginosa was statistically decease[RR = 0. 38,95 % CI（0. 15,0. 94） P = 0. 04]. No severe adverse events were found in all included studies. CONCLUSION The present evidence is not strong enough to prove that probiotics is effective to prevent VAP and reduce the mortality. However, the results of this Meta-analysis should be interpre- ted with caution because of the heterogeneity among study designs and ICU specialty. Large sample and high-quality randomized controlled trials are needed for further evaluation.
出处
《中国医院药学杂志》
CAS
CSCD
北大核心
2014年第3期208-215,共8页
Chinese Journal of Hospital Pharmacy
关键词
益生菌
预防
呼吸机相关性肺炎
系统评价
META分析
probiotics
prevention
ventilator-associated pneumonia
systematic review
Meta-analysis
