我国医疗环境下尿道口清洁与消毒护理预防留置导尿管伴随性尿路感染效果的Meta分析

摘要

Objective To systematically review the preventive efficacy of urethral orifice cleaning versus disinfection for urethral catheter associated urinary tract infections(CA-UTI)in China.Methods PubMed,Embase,The Cochrane Library(Issue 9),CBM,CNKI,VIP and WanFang Data were searched from their establishment to Sep.2016 to collect relevant randomized controlled trials(RCTs)comparing urethral orifice cleaning and disinfection for preventing CA-UTI in China.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.The meta-analysis was performed using RevMan5.3 software.Results A total of 25 RCTs involving 2780 patients were included.The results of meta-analysis showed as follows.①There was no significant difference on asymptomatic bacteriuria rate between urethral orifice cleaning group and disinfection group at the third day(RR=1.00,95％ CI 0.69～1.43,P=0.89)and the seventh to tenth day(RR=0.95,95％ CI 0.71～1.27,P=0.72).Asymptomatic bacteriuria rate was lower in urethral orifice cleaning group than that in disinfection group at the fourteenth day;②There was no significant difference on urinary tract infection rate between urethral orifice cleaning group and disinfection group at the third day(RR=1.14,95％ CI 0.76～1.71,P=0.53),the seventh to tenth day(RR=1.04,95％ CI 0.77～1.40,P=0.80)and the fourteenth day(RR=1.02,95％ CI 0.73～1.45,P=0.89);③Rates of adverse effects including skin allergy and inflamed hot pain were significantly lower in urethral orifice cleaning group than those in disinfection group(RR=0.23,95％ CI 0.09～0.61,P=0.003).Conclusion Current evidence demonstrates that urethral orifice cleaning is comparable to disinfection for preventing CA-UTI in China.In addition,urethral orifice cleaning has lower rate of asymptomatic bacteriuria and less adverse effect than disinfection.%目的 系统评价我国医疗环境下尿道口清洁与消毒护理预防留置导尿管伴随性尿路感染(catheter associated urinary tract infections,CA-UTI)的效果.方法 计算机检索PubMed、Embase、The Cochrane Library(第9期)、CBM、CNKI、VIP和WanFang Data数据库,搜集国内尿道口清洁与消毒护理预防CA-UTI的相关随机对照试验(randomized controlled trial,RCT),检索时限均为建库至2016年9月.由两名评价者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果 最终纳入25个RCT,共计2780例患者.Meta分析结果显示:①无症状性菌尿发生率方面,清洁组与消毒剂组在第3天(RR=1.00,95％ CI 0.69～1.43;P=0.89)和第7～10天(RR=0.95,95％ CI 0.71～1.27;P=0.72)无症状性菌尿发生率的差异无统计学意义,清洁组的第14天无症状性菌尿发生率显著低于消毒组(RR=0.64,95％ CI 0.45～0.92;P=0.01);②尿路感染发生率方面,清洁组在第3天(RR=1.14,95％ CI 0.76～1.71;P=0.53)、第7～10天(RR=1.04,95％ CI 0.77～1.40;P=0.80)和第14天(RR=1.02,95％ CI 0.73～1.45;P=0.89)尿路感染发生率与消毒组比较差异无统计学意义;③不良反应方面,主要为皮肤过敏和红肿热痛,清洁组的不良反应发生率显著低于消毒组(RR=0.23,95％ CI 0.09～0.61;P=0.003).结论 当前证据显示,国内尿道口清洁护理预防CA-UTI的疗效与消毒护理相当,且无症状性菌尿更少及具有更高的安全性.