选择性消化道去污染防治重症感染监护病房医院感染的系统评价

摘要

目的：运用循证医学理论和方法，就选择性消化道去污染(SDD)防治重症感染监护病房医院感染的疗效和安全性进行系统评价。方法：采用Cochrane系统评价的方法，计算机检索PubMed(1995-2012)、EMBASE(1995-2012)、Cochrane图书馆(2012年第3期)、中国生物医学文献数据库CBMdisc(1995-2012)、中国学术期刊全文数据库CNKI(1995-2012)、中文科技期刊全文数据库VIP(1995-2012)，手工检索2002-2012相关杂志。两个评价员首先独立地阅读文章标题及，如符合纳入标准则阅读全文，并进行数据资料提取及质量评价，不同意见通过讨论解决或由第三方判断。从随机方法、分配隐藏、盲法、有无失访几方面，对纳入研究的方法学质量进行评价，数据采用RevMan4.2软件进行统计分析。结果：通过电子检索与手工检索，获得相关文献共5738篇，经质量评估筛选后，其中9个随机对照试验(包含13685例患者)符合纳入标准，对其进行了系统评价。经分析，9个研究均介绍了随机分配方法，但未具体描述分配隐藏；6个研究对干预措施、实施环节和(或)终点指标测量环节均实施盲法，质量等级均为B级；另3个研究对以上环节未实施任何盲法，质量等级均为C级。Meta分析结果显示，试验组和对照组死亡率分别为23.3%、25.2%，RR 0.93，95%CI(0.86，0.99)，两组比较差异有统计学意义(P<0.05)；下呼吸道感染率分别为29.5%、45.9%，RR 0.64，95%CI(0.54，0.76)，两组比较差异有统计学意义(P<0.0001)；血流感染率分别为5.7%、10.8%，RR 0.63，95%CI(0.49，0.82)，两组比较差异有统计学意义(P<0.001)；尿路感染率分别为9.4%、15.5%，RR 0.60，95%CI(0.41，0.87)，两组比较差异有统计学意义(P<0.01)。纳入的9个研究均未报道重症患者与SDD相关的不良反应。结论：与对照组相比，SDD能安全有效降低重症监护病房患者死亡率及感染发生率。%Objective:To systematically review the efficacy and safety of selective decontamination of digestive tract(SDD)for preventing hospital infection in intensive care unit(ICU).Method:According to principles of Evidence Based Medicine(EBM),we searched PubMed(1995-2012), EMBASE(1995-2012),Cochrane Library(Issue 3,2012),Chinese Biomedical Literature Database (CBMdisc)(1995-2012),China National Knowledge Infrastructure (CNKI)(1995-2012),VIP database(1995-2012),and hand searched several related Chinese journals in the past ten years.Two reviewers independently screened the studies for eligibility,extracted data and evaluated their methodological quality.The titles and abstracts of every record retrieved were firstly scanned to determine which were possibly relevant to our review.Any record that appeared likely to meet the inclusion criteria was obtained in full text.Differences in opinion between reviewers were resolved by discussion or decided by the third party.The methodological quality of the included trials such as randomization,allocation concealment,blind and following-up was assessed.Meta-analysis was performed by using RevMan 4.2 software. Result:A total of 5738 studies were identified by both electronic and hand searches.After the process of quality assessment,9 randomized control trails including 13 685 patients,which met our inclusion criteria,were included. All the nine included studies mentioned the randomization procedure,but no allocation concealment was described.6 studies carried out blind in each step,so we considered each of the 6 studies was at moderate risk of different biases and graded as category“B”.While 3 other studies used no blind at all,so we considered each of the 3 studies was at high risk of different biases and graded as category“C”.Based on Meta-analysis,the mortality rate (treatment group versus control group) were 23.3%,25.2%,respectively,RR 0.93,95%CI(0.86,0.99)(P<0.05).The lower respiratory tract infection rate(treatment group versus control group) were 29.5%,45.9%,respectively, RR 0.64,95%CI(0.54,0.76)(P<0.0001).The bloodstream infection rate (treatment group versus control group) were 5.7%,10.8%,respectively,RR 0.63,95%CI(0.49,0.82)(P<0.001).The urinary tract infection rate(treatment group versus control group) were 9.4%,15.5%,respectively,RR 0.60, 95%CI(0.41,0.87)(P<0.01).In addition,no data regarding ICU patients’adverse events associated with SDD were reported.Conclusion:Compared with placebo,SDD could effectively and safely reduce the mortality rate and hospital infection rate of ICU patients.