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目的:系统评价万古霉素首剂给予负荷剂量对患者临床结局的影响。方法:系统检索英文数据库Pub Med,Embase,Cochrane Library,中文数据库CNKI,Wan Fang,CBM,纳入所有关于万古霉素首剂给予负荷剂量的研究。结局指标为感染治疗的有效率、目标浓度的达标率和肾毒性的发生率。结果:纳入1篇随机对照试验,2篇队列研究,共199名患者,其中1篇研究报道负荷剂量可以提高感染治疗的有效率[RR=1.27,95%CI(0.97,1.67),P>0.05],2篇研究报道负荷剂量可以提高目标浓度的达标率[RR=1.54,95%CI(0.72,3.30),P>0.05],1篇研究报道负荷剂量组与对照组的肾毒性发生率[RR=3.87,95%CI(0.46,32.57),P>0.05]。结论:万古霉素首剂给予负荷剂量可以提高感染治疗的有效率和目标浓度的达标率,但未显示出临床优势。
OBJECTIVE: To systematically evaluate the effect of vancomycin first dose on the clinical outcome of patients. Methods: Pub Med, Embase, Cochrane Library, Chinese database CNKI, Wan Fang and CBM were systematically searched. All the studies on loading dose of vancomycin were included. Outcome measures for the effectiveness of infection treatment, target concentration and the incidence of nephrotoxicity. RESULTS: One randomized controlled trial, two cohort studies, of 199 patients were included. One of the studies reported that loading dose increased the effectiveness of infection treatment [RR = 1.27, 95% CI (0.97, 1.67), P> 0.05 ], Two studies reported that the loading dose can improve the target rate of compliance [RR = 1.54,95% CI (0.72,3.30), P> 0.05], a study reported loading dose group and control group, the incidence of nephrotoxicity [ RR = 3.87, 95% CI (0.46, 32.57), P> 0.05]. Conclusion: The first dose of vancomycin can improve the efficiency of infection treatment and the target rate of target concentration, but did not show the clinical advantage.