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目的系统评价重症急性胰腺炎(SAP)预防性应用抗菌药物的疗效及其临床意义,为临床合理使用提供依据。方法计算机检索MEDLINE、EMbase、Cochrane图书馆临床对照试验资料库、CBMdisc和CNKI,检索时间均从建库至2010年8月,收集重症急性胰腺炎预防性使用抗菌药物的随机对照试验(RCT)。对符合纳入标准的临床研究进行资料提取和质量评价后,采用RevMan 5.0软件进行Meta分析。结果最终纳入12个随机对照试验,共777例患者。Meta分析结果显示,与对照组相比,预防性使用抗菌药物组在降低SAP病死率[RR=0.75,95%CI(0.50,1.12)]、减少坏死性胰腺感染[RR=0.82,95%CI(0.63,1.09)]、手术干预[RR=0.97,95%CI(0.74,1.26)]和胰腺外感染[RR=0.73,95%CI(0.48,1.10)]方面均无优势。结论现有临床研究证据显示,SAP患者预防性使用抗菌药物并不能有效降低感染性坏死的发生率、病死率及手术干预率。
Objective To systematically evaluate the efficacy and clinical significance of prophylactic use of antimicrobial agents in patients with severe acute pancreatitis (SAP), and provide a basis for clinical rational use. Methods The MEDLINE, EMbase, Cochrane Library Clinical Controlled Trials Database, CBMdisc and CNKI were searched by computer. The search time was from the database to August 2010. Randomized controlled trials (RCTs) were conducted to collect antimicrobial agents for severe acute pancreatitis. Meta-analysis was performed using RevMan 5.0 software after data extraction and quality evaluation of clinical studies that met the inclusion criteria. The results eventually included 12 randomized controlled trials, a total of 777 patients. Meta-analysis showed that prophylactic use of antimicrobials decreased SAP mortality [RR = 0.75, 95% CI (0.50, 1.12)] and decreased necrotizing pancreatic infection compared with controls (RR = 0.82, 95% CI (0.63, 1.09), surgical intervention (RR = 0.97, 95% CI 0.74, 1.26) and extrapancreatic infection (RR 0.73, 95% CI 0.48, 1.10). Conclusions The evidence from current clinical studies shows that prophylactic use of antimicrobial agents in patients with SAP can not effectively reduce the incidence of infectious necrosis, mortality and surgical intervention rate.