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目的 评价颅底骨折患者预防性使用抗生素预防脑膜炎的效果.方法 检索Cochrane临床对照试验资料库(CENTRAL)(Cochrane图书馆2005年第3期)、MEDLINE(1966～2005.09)、EMBASE(1974～2005.06)和LILACS(1982～2005.09).电子检索美国神经外科医师协会会议记录(1997～2005.09),手工检索神经外科学会欧洲联合会会议记录摘要(1995,1999,2003).收集比较抗生素与安慰剂或空白对照的随机对照试验.同时对检出的非随机对照试验单独进行Meta分析以比较结果.至少由两名研究者独立评价每项试验的质量并提取示?采用RevMan 4.2软件进行Meta分析.结果 纳入的5个随机对照试验和17个非随机对照试验比较了颅底骨折患者使用不同类型的预防性抗生素与安慰剂或空白对照的效果.但多数试验对方法学细节描述不充分.所有试验均将脑膜炎纳入其主要结局.共评价了符合Meta分析纳入标准的四个随机对照试验,共包括208例受试者.在降低脑膜炎的发生率、全因病死率、脑膜炎病死率和需要手术干预的脑脊液漏的发生率等方面,预防性抗生素组与对照组无显著差异.对伴或不伴脑脊液漏的患者进行亚组分析以评价其主要结局.并对所有检出的非随机对照试验(共包括2 168例受试者)进行Meta分析,得出的结果与随机数据一致.结论 现有的随机对照试验证据并不支持对颅底骨折患者预防性使用抗生素,无论其有无脑脊液漏的迹象.在更多的研究完成之前,尚无法确定颅底骨折患者使用抗生素的效果,因为迄今发表的研究均存在偏倚,尚需更多设计完善的大样本随机对照试验.“,”Objectives We tended to evaluate the effectiveness of prophylactic antibiotics for preventing meningitis in patients with BSF.Method We searched the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to September 2005), EMBASE (1974 to June 2005), and LILACS (1982 to September 2005). We also performed an electronic search of meeting proceedings from the American Association of Neurological Surgeons (1997 to September 2005) and handsearched the abstracts of meeting proceedings of the European Association of Neurosurgical Societies (1995, 1999 and 2003). Randomized controlled trials (RCTs) comparing any antibiotic versus placebo or no intervention were identified. We also identified nonRCTs to perform a separate meta-analysis to compare results. At least two authors independently appraised the quality and extracted the data of each trial. Metaanalysis was conducted using RevMan 4.2 software.Results Five RCTs and 17 non-RCTs comparing different types of antibioticprophylaxis with placebo or no intervention in patients with BSF were identified.Most trials presented insufficient methodological detail. All studies included meningitis in their primary outcome. Overall, we evaluated 208 participants from the four RCTs that were considered suitable for inclusion in the meta-analysis. There were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of the frequency of meningitis, all-cause mortality,meningitis-related mortality, and need for surgical correction in patients with CSF leakage. We performed a subgroup analysis to evaluate the primary outcome in patients with and without CSF leakage. We also completed a meta-analysis of all the identified controlled non-RCTs (enrolling a total of 2 168 patients), producing results consistent with the randomised data.Conclusions Currently available evidence from RCTs does not support prophylactic antibiotic use in patients with BSF, whether there is evidence of CSF leakage or not. Until more research is completed, the effectiveness of antibiotics in patients with BSF cannot be determined because studies published to date are flawed by biases. Large, appropriately designed RCTs are needed.