万古霉素静脉滴注与联合鞘内注射治疗颅内感染效果及安全性的Meta分析

摘要

Objective To analyze the efficacy and safety of vancomycin intravenous drip infusion and intravenous drip infusion combined with intrathecal injection in treatmem of imracranial infection.Methods Casecontrol studies about vancomycin intravenous drip infusion and intrathecal injection combined with intravenous drip infusion treating intracranial infection were searched in Pubmed,Cochrane Library,Elsevier Clinical Key,FMJS,Chinese Journal Full-text Database,Chinese Biomedical Literature Database,Wanfang Database and VIP Database until June 2017.Revman 5.3 software was used for data analysis.Results Five respective cohort studies including 248 patients were reviewed;112 patients were treated by intravenous drip infusion of vancomycin;136 patients were treated by vancomycin via intravenous drip infusion combined with intrathecal injection.Meta analysis showed that the clinical effective rate(odds ratio =6.24,95％ confidence interval:2.68-14.54,P ＜0.001) and healing time(odds ratio =-4.78,95％ confidence interval:-7.59 to-1.96,P ＜ 0.001) had significant differences between intravenous drip infusion group and intravenous drip infusion combined with intrathecal injection group;adverse drug reactions showed no significant difference between groups[OR =1.38,95％ confidence interval:0.43-4.50,P =0.59].Conclusion Vancomycin intravenous drip infusion combined with intrathecal injection treating intracranial infection is better than intravenous drip infusion in improving clinical efficacy and shortening cure time without increasing adverse reaction.%目的 比较万古霉素静脉滴注与静脉滴注联合鞘内注射治疗颅内感染的效果及安全性.方法 计算机检索Pubmed、The Cochrane Library、Elsevier Clinical Key、FMJS以及中国期刊全文数据库、中国生物医学文献数据库、万方数据库、维普中文科技期刊数据库中的文献,检索时限为建库时间至2017年6月.搜集关于万古霉素静脉滴注与静脉滴注联合鞘内注射2种不同给药方式治疗颅内感染的病例对照研究,对检索到的文献进行数据提取和质量评价,并采用Revman5.3软件进行Meta分析.结果 最终纳入5篇回顾性队列研究,共248例患者,其中静脉滴注组112例,静脉滴注联合鞘内注射组136例.Meta分析结果显示:静脉滴注组与静脉滴注联合鞘内注射组临床有效率(比值比=6.24,95％置信区间:2.68～14.54,P＜0.001)及治愈时间(比值比=-4.78,95％置信区间:-7.59～-1.96,P＜0.001)比较差异均有统计学意义,2种不同给药方式所致不良反应(比值比=1.38,95％置信区间:0.45 ～4.50,P=0.59)比较差异无统计学意义.结论 万古霉素静脉滴注联合鞘内注射治疗颅内感染的临床有效率高于静脉滴注组,并能缩短治疗时间,且不增加不良反应.