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目的采用Meta分析了解我国近16年来上呼吸道感染(以下简称上感)患儿抗生素使用率情况,从而评价新医改以来国家颁布的有关合理用药政策的有效性。方法检索中国期刊全文数据库(CNKI)、维普(VIP)、万方中有关中国儿童上呼吸道感染抗生素使用率的研究文献,在Pubmed、Ebsco、Web of Science、Embase中检索研究现场为中国大陆地区的外文文献并进行Meta分析,同时通过文献研究时间、地区和机构类别来进行对比研究。结果符合入选标准文献共32篇,总样本量54 189例。经Meta分析发现,我国儿童上感抗生素使用率合并值为89.2%(95%CI=82.22%~96.2%)。2009年前后儿童上感抗生素使用率分别为92.2%和87.6%;东部、中部和西部儿童上感抗生素使用率分别为88.3%、88.4%和93.3%;三级医院、二级医院及基层医疗机构(包括一级医院、社区卫生服务中心和乡镇卫生院)儿童上感抗生素使用率分别为85.2%、92.2%和90.2%。结论我国儿童上感抗生素使用率相对较高,且在不同时间、地区和医疗机构类别间使用率存在差别,医改政策颁布后其使用率下降,可能与政策实施有一定相关性。
Objective To investigate the use of antibiotics in children with upper respiratory tract infection (referred to as upper flu) in recent 16 years by Meta-analysis to evaluate the effectiveness of rational drug-use policies promulgated by the state since the new medical reform. Methods The research articles of CNKI, VIP and Wanfang on the usage of antibiotics in children with upper respiratory tract infection in China were searched. The research sites were searched in Pubmed, Ebsco, Web of Science and Embase Foreign literature and Meta-analysis, at the same time through the literature study of time, region and type of institutions to carry out comparative studies. The results meet the inclusion criteria of a total of 32 articles, the total sample size of 54,189 cases. Meta-analysis showed that the combined use rate of antibiotics in Chinese children was 89.2% (95% CI = 82.22% -96.2%). The prevalence rates of antibiotics in children before and after 2009 were 92.2% and 87.6%, respectively. The prevalence rates of antibiotics in the children in eastern, middle and western regions were 88.3%, 88.4% and 93.3% respectively. The levels of tertiary hospitals, secondary hospitals and primary medical institutions (Including primary hospitals, community health centers and township hospitals), the prevalence rates of antibiotics in children were 85.2%, 92.2% and 90.2% respectively. Conclusion The usage rate of antibiotics in children is relatively high in our country. There are differences in usage rates between different types of medical institutions at different times and regions. The rate of utilization of medical reform policies declines after they are promulgated, which may be related to the implementation of policies.