中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

益生菌对呼吸机相关性肺炎影响的系统评价

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目的系统评价益生菌对预防呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的效果及安全性。方法检索 Web of Science、Pubmed、OVID、Cochrane Library、EMbase、Sciencedirect、中国生物医学数据库、CNKI 及万方数据库。检索时限从建库起至 2017 年 8 月。同时手工检索相关数据资源。收集益生菌用于预防 VAP 的随机对照试验,用改良版 Jadad 量表评价纳入研究的质量,采用 RevMan 5.3 软件进行统计学处理。结果纳入文献 16 篇。预防性使用益生菌能够降低 VAP 的发生率[RR=0.71,95%CI(0.62,0.80),P<0.000 01]、ICU 住院天数[MD=–3.28,95%CI(–6.15,–0.41),P=0.03]及总抗生素使用天数[MD=–2.47,95%CI(–4.89,–0.04),P=0.05],但并不能降低 ICU 死亡率[RR=0.99,95%CI(0.74,1.32),P=0.94]、医院死亡率[RR=0.77,95%CI(0.58,1.01),P=0.06]、28 天死亡率[RR=1.01,95%CI(0.69,1.47),P=0.97]、90 天死亡率[RR=1.00,95%CI(0.72,1.37),P=0.99]、医院住院天数[MD=–0.68,95%CI(–3.88,2.52),P=0.68]、机械通气时间[MD=–2.17,95%CI(–4.78,0.44),P=0.10]以及腹泻发生率[RR=0.96,95%CI(0.80,1.14),P=0.62]等。纳入研究均无严重不良事件。结论益生菌的使用能显著降低 VAP 的发生率,但对死亡率、医院住院天数、机械通气时间、腹泻的发生率无显著影响。鉴于研究设计间存在一定异质性,尚需更多设计严谨的大样本随机对照研究以增加证据的强度。

ObjectiveTo systematically evaluate the efficacy and safety of probiotics for prevention of ventilator-associated pneumonia (VAP).MethodsThe Web of Science, Pubmed, OVID, Cochrane Library, CNKI, EMbase, Sciencedirect, Chinese biomedical database, and Wanfang database before August 2017 were searched, and the relevant data resources were also searched by hand to collect randomized controlled trials (RCTs) of probiotics for prevention of VAP. The quality of the included studies was evaluated using a modified version of the Jadad scale. Meta-analysis was performed with RevMan 5.3 software.ResultsA total of 16 RCTs were included. The use of probiotics can reduce the incidence of VAP [RR=0.71, 95%CI (0.62, 0.80), P<0.000 01], ICU days [MD=–3.28, 95%CI (–6.15, –0.41), P=0.03] and total duration of antibiotics [MD=–2.47, 95%CI (–4.89, –0.04), P=0.05], but can not reduce the mortality of ICU [RR=0.99, 95%CI (0.74, 1.32), P=0.94], hospital mortality [RR=0.77, 95%CI (0.58, 1.01), P=0.06], 28-day mortality [RR=1.01, 95%CI (0.69, 1.47), P=0.97], 90-day mortality [RR=1.00, 95%CI (0.72, 1.37), P=0.99], hospital stays [MD=–0.68, 95%CI (–3.88, 2.52), P=0.68], duration of mechanical ventilation [MD=–2.17, 95%CI (–4.78, 0.44), P=0.10], or the incidence of diarrhea [RR=0.96, 95%CI (0.80, 1.14), P=0.62]. No serious adverse events were reported in all included RCTs.ConclusionsThe use of probiotics can reduce the incidence of VAP, but it has no effect on the mortality, hospital stay, duration of mechanical ventilation or the incidence of diarrhea. However, considering the heterogeneity of research designs, we need more rigorous, large sample randomized controlled studies to increase the strength of evidence.

关键词: 益生菌; 机械通气; 呼吸机相关性肺炎

Key words: Probiotics; Mechanical ventilation; Ventilator-associated pneumonia

引用本文: 魏璐, 张先红, 王琪, 余静. 益生菌对呼吸机相关性肺炎影响的系统评价. 中国呼吸与危重监护杂志, 2018, 17(2): 144-154. doi: 10.7507/1671-6205.201709015 复制

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