霧化吸入多黏菌素輔助治療呼吸機(jī)相關(guān)性肺炎療效與安全性的Meta分析

羅夢林 王璇 白浩 陳萬一

中圖分類號 R563.1;R974 文獻(xiàn)標(biāo)志碼 A 文章編號 1001-0408（2021）19-2400-06

DOI 10.6039/j.issn.1001-0408.2021.19.16

摘 要 目的：系統(tǒng)評價霧化吸入多黏菌素輔助治療呼吸機(jī)相關(guān)性肺炎的療效與安全性，為臨床治療提供循證參考。方法：計算機(jī)檢索Cochrane Library、Embase、PubMed、Web of Science、中國期刊全文數(shù)據(jù)庫、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫、中文科技期刊數(shù)據(jù)庫、萬方數(shù)據(jù)庫（檢索時限均為建庫至2021年3月）中關(guān)于霧化吸入多黏菌素聯(lián)合常規(guī)治療（試驗組）對比常規(guī)治療（對照組）對呼吸機(jī)相關(guān)性肺炎的療效和安全性的隨機(jī)對照試驗（RCT）及隊列研究。對符合納入與排除標(biāo)準(zhǔn)的文獻(xiàn)進(jìn)行資料提取和質(zhì)量評價后，采用RevMan 5.4軟件進(jìn)行Meta分析。結(jié)果：共納入13項臨床研究，包括2項RCT和11項隊列研究，共計1 066例患者。Meta分析結(jié)果顯示，試驗組患者的臨床有效率[OR=1.53，95%CI（1.17，2.00），P=0.002]、微生物清除率[OR=1.46，95%CI（1.11，1.91），P=0.007]均顯著高于對照組，差異均有統(tǒng)計學(xué)意義;兩組患者的全因死亡率[OR=0.88，95%CI（0.68，1.14），P=0.32]、腎功能損害發(fā)生率[OR=1.04，95%CI（0.72，1.49），P=0.85]比較，差異均無統(tǒng)計學(xué)意義。結(jié)論：基于現(xiàn)有臨床證據(jù)，霧化吸入多黏菌素聯(lián)合常規(guī)治療能顯著提高呼吸機(jī)相關(guān)性肺炎患者的臨床有效率和微生物清除率。但本結(jié)論尚需要更多設(shè)計嚴(yán)格、長期隨訪的大樣本RCT加以證實。

關(guān)鍵詞 霧化吸入;多黏菌素;呼吸機(jī)相關(guān)性肺炎;Meta分析;療效;安全性

Efficacy and Safety of Atomization Inhalation of Polymyxin in the Adjunctive Treatment of Ventilator- associated Pneumonia： A Meta-analysis

LUO Menglin1，WANG Xuan1，BAI Hao2，CHEN Wanyi2（1. Dept. of Pharmacy， the Second Affiliated Hospital of the Army Medical University， Chongqing 400037，China;2. Dept. of Pharmacy，Chongqing University Affiliated Cancer Hospital， Chongqing 400030，China）

ABSTRACT ? OBJECTIVE： To evaluate the efficacy and safety of atomization inhalation of polymyxin combined in the adjunctive treatment for ventilator-associated pneumonia， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from Cochrane Library， Embase， PubMed， Web of Science， CNKI， CBM， VIP and Wanfang database （from their inception to March 2021）， randomized controlled trials （RCTs） about efficacy and safety of atomization inhalation of polymyxin combined with conventional treatment （trial group） versus conventional treatment （control group） for ventilator- associated pneumonia were collected. After data extraction and quality evaluation of included literatures met inclusion and exclusion criteria， Meta-analysis was performed by using RevMan 5.4 software. RESULTS： A total of 13 clinical studies were included， involving 2 RCTs and 11 cohort studies with a total of 1 066 patients. The results of Meta-analysis showed that clinical response rate [OR=1.53， 95%CI （1.17，2.00） ，P=0.002]， microbial clearance rate [OR=1.46， 95%CI（1.11，1.91）， P=0.007] of trial group were significantly higher than those of control group， with statistical significance. There was no statistical significance in the mortality rate [OR=0.88， 95%CI（0.68，1.14）， P=0.32] and the incidence of renal impairment [OR=1.04， 95%CI （0.72， 1.49）， P=0.85] between 2 groups. CONCLUSIONS： Based on current evidence， atomization inhalation of polymyxin combined with conventional treatment can significantly improve clinical response rate and microbial clearance rate of patients with ventilator-associated pneumonia. However， more strictly-designed， long-term follow-up and large-scale RCTs are needed.