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目的:系统评价美罗培南治疗腹腔内感染的临床有效性及安全性。方法:根据纳入及排除标准,计算机检索Medline、Cochrane图书馆、PubMed、Embase、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)和中华医学会数字化期刊(Wanfang),纳入美罗培南治疗腹腔内感染的随机对照试验(RCT)。根据Cochrane手册对纳入的RCT进行治疗评价,并通过RevMan 5.2软件进行Meta分析。结果:本研究共纳入19个RCT,纳入的总样本量为2 486例。Meta分析结果显示,美罗培南的临床有效率优于亚胺培南/西司他丁[RR=1.01,95%CI(0.98,1.04),P=0.61],低于头孢噻肟与甲硝唑联用[RR=0.95,95%CI(0.90,0.99),P=0.01];美罗培南的厌氧菌清除率优于头孢噻肟与甲硝唑联用[RR=1.02,95%CI(0.89,1.17),P=0.78];美罗培南的大肠埃希菌清除率低于亚胺培南/西司他丁[RR=0.96,95%CI(0.88,1.05),P=0.39],优于头孢噻肟与甲硝唑联用[RR=1.04,95%CI(0.83,1.31),P=0.73]以及妥布霉素与克林霉素联用[RR=1.09,95%CI(1.02,1.17),P=0.01];美罗培南的安全性优于亚胺培南/西司他丁[RR=0.89,95%CI(0.69,1.15),P=0.37]及头孢噻肟与甲硝唑联用[RR=0.63,95%CI(0.40,0.97),P=0.04]。除美罗培南临床有效率低于头孢噻肟与甲硝唑联用、大肠埃希菌清除率优于妥布霉素与克林霉素联用、安全性优于头孢噻肟与甲硝唑联用的结果差异有统计学意义(P<0.05)以外,其余结果差异均无统计学意义(P>0.05)。结论:在治疗腹腔感染时,美罗培南的临床有效率和安全性与亚胺培南/西司他丁相当;而美罗培南的临床有效率比头孢噻肟与甲硝唑联用低,但安全性更高。
Objective: To evaluate the clinical efficacy and safety of Meropenem in the treatment of intraperitoneal infection. METHODS: Medline, Cochrane Library, PubMed, Embase, Chinese Journal Full-text Database (CNKI), Chinese Science and Technology Periodical Full-text Database (VIP) and Wanfang were searched by computer according to inclusion and exclusion criteria. Randomized controlled trial of intraperitoneal infection (RCT). The included RCTs were evaluated for therapies according to the Cochrane Handbook and Meta-Analyzed using RevMan 5.2 software. Results: A total of 19 RCTs were included in this study, with a total of 2 486 patients included. Meta-analysis showed that the clinical efficacy of Meropenem was superior to imipenem / cilastatin [RR = 1.01, 95% CI (0.98, 1.04), P = 0.61], lower than that of cefotaxime Meropenem had better anaerobic clearance than cefotaxime with metronidazole [RR = 0.95, 95% CI (0.90, 0.99), P = 0.01] , 1.17), P = 0.78]. The clearance rate of meropenem was lower than that of imipenem / cilastatin [RR = 0.96,95% CI (0.88,1.05), P = 0.39] Cefotaxime was used in combination with metronidazole [RR = 1.04, 95% CI (0.83, 1.31), P = 0.73] and tobramycin with clindamycin [RR = 1.09, 95% CI 1.17), P = 0.01]. The safety of meropenem was superior to imipenem / cilastatin [RR = 0.89,95% CI (0.69,1.15), P = 0.37] [RR = 0.63, 95% CI (0.40, 0.97), P = 0.04]. In addition to the clinical efficacy of Meropenem in combination with cefotaxime metronidazole, Escherichia coli clearance is superior to tobramycin and clindamycin, safety is superior to cefotaxime and metronidazole Results were statistically significant (P <0.05), the rest of the differences were not statistically significant (P> 0.05). Conclusions: The clinical efficacy and safety of meropenem are comparable to imipenem / cilastatin in the treatment of intra-abdominal infections, whereas the clinical efficacy of meropenem is lower than that of cefotaxime and metronidazole, but safety Sex is higher.