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目的:系统评价美罗培南改良输注方式(2~4 h输注或持续24 h输注)对比传统输注方式(0.5~1 h输注)治疗严重感染的疗效和安全性,以为临床治疗提供循证参考。方法:计算机检索Medline、中国期刊全文数据库、中文科技期刊数据库、万方数据库,检索美罗培南改良输注方式(试验组)对比传统输注方式(对照组)治疗严重感染的系列研究,提取资料并评价质量后,采用Rev Man 5.0统计软件进行Meta分析。结果:共纳入13项临床研究,合计1 012例患者。Meta分析结果显示,试验组患者临床有效率[RR=1.25,95%CI(1.10,1.43),P<0.001]和细菌清除率[RR=1.25,95%CI(1.05,1.48),P=0.01]显著高于对照组,而死亡率[RR=0.74,95%CI(0.46,1.18),P=0.21]和不良反应发生率[RR=0.81,95%CI(0.48,1.39),P=0.45]与对照组比较,差异无统计学意义。结论:与传统输注方式相比,延长或持续输注美罗培南可提高治疗严重感染的疗效,两者安全性相当。受纳入研究方法学质量的限制,该结论有待大样本、高质量的随机对照试验进一步验证。
OBJECTIVE: To evaluate the efficacy and safety of Meropenem in the treatment of severe infections by modified infusion (2 ~ 4 h infusion or continuous 24 h infusion) compared with the traditional infusion method (0.5 ~ 1 h infusion) in order to provide clinical treatment Evidence-based reference. METHODS: A series of computer-based searches of Medline, Chinese Journal Full-text Database, Chinese Sci-tech Periodicals Database and Wanfang Database were conducted to search for a series of studies comparing Meropenem’s modified infusion method (experimental group) with traditional infusion methods (control group) After evaluating the quality, Meta-analysis was performed using RevMan 5.0 statistical software. Results: A total of 13 clinical studies were included, totaling 1 012 patients. Meta-analysis showed that the clinical effective rate (RR = 1.25, 95% CI 1.10, 1.43, P <0.001) and bacterial clearance rate in the test group [RR = 1.25,95% CI ] Was significantly higher than that of the control group, while the mortality rate [RR = 0.74,95% CI (0.46,1.18), P = 0.21] and incidence of adverse reactions [RR = 0.81,95% CI (0.48,1.39) ] Compared with the control group, the difference was not statistically significant. CONCLUSIONS: Prolonged or sustained infusion of meropenem improves the efficacy of treatment of severe infections compared to traditional infusion methods, both of which are comparable in safety. Subject to the limitations of research methodology quality, this conclusion needs to be further validated by large sample, high-quality randomized controlled trials.