重癥急性胰腺炎預防性抗菌藥物治療的Meta分析_《中國循證醫學雜志》

作者：

王燕萍 ¹ ,  李德榜 ² , 董春祿 ² , 武新安 ¹

1. 蘭州大學第一醫院藥劑科（蘭州 730000）；2. 蘭州大學第一醫院普外科（蘭州 730000）;

關鍵詞：

抗菌藥物預防性應用重癥急性胰腺炎 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20120074

視頻：

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目的　系統評價重癥急性胰腺炎（SAP）預防性應用抗菌藥物的療效及其臨床意義，為臨床合理使用提供依據。
方法　計算機檢索MEDLINE、EMbase、Cochrane圖書館臨床對照試驗資料庫、CBMdisc和CNKI，檢索時間均從建庫至2010年8月，收集重癥急性胰腺炎預防性使用抗菌藥物的隨機對照試驗（RCT）。對符合納入標準的臨床研究進行資料提取和質量評價后，采用RevMan 5.0軟件進行Meta分析。
結果　最終納入12個隨機對照試驗，共777例患者。Meta分析結果顯示，與對照組相比，預防性使用抗菌藥物組在降低SAP病死率［RR=0.75，95%CI（0.50，1.12）］、減少壞死性胰腺感染［RR=0.82，95%CI（0.63，1.09）］、手術干預［RR=0.97，95%CI（0.74，1.26）］和胰腺外感染［RR=0.73，95%CI（0.48，1.10）］方面均無優勢。
結論　現有臨床研究證據顯示，SAP患者預防性使用抗菌藥物并不能有效降低感染性壞死的發生率、病死率及手術干預率。

引用本文： 王燕萍 ,李德榜,董春祿,武新安. 重癥急性胰腺炎預防性抗菌藥物治療的Meta分析. 中國循證醫學雜志, 2012, 12(4): 477-483. doi: 10.7507/1672-2531.20120074 復制

1.	Isenmann R, Rünzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis a placebo-controlled, double-blind trial. Gastroenterology, 2004, 126(4): 997-1004.
2.	Sainio V, Kemppainen E, Puolakkainen P, et al. Early antibiotic treatment in acute necrotizing pancreatitis. Lancet, 1995, 346(8976): 663-667.
3.	Pederzoli P, Bassi C, Vesentini S. A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet, 1993, 176(5): 480-483.
4.	Banks PA, Freeman ML. The Practice Parameters Committee of the American College of Gastroenterology: practiceguidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10): 2379-2400.
5.	Garcia-Barrasa A, Borobia F, Pallares R, et al. A double-blind, placebo-controlled trial of cipro?oxacin prophylaxis in patients with acute necrotizing pancreatitis. J Gastrointest Surg, 2009, 13(4): 768-774.
6.	Xong GS, Wu SM, Wang ZH. Role of ProPhylactic antibiotic administration in severe acute Pancreatitis: a meta-analysis. Med Princ Pract, 2006, 15(2): 106-110.
7.	Dambrauskas Z, Gulbinas A, Pundzius J, et al. Meta-analysis of ProPhylactic Parenteral antibiotic use in acute necrotizing Panereatitis. Medicina (kaunas), 2007, 43(4): 291-300.
8.	Dellinger EP, Tellado JM, Soto NE, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: randomized, double-blind placebo-controlled study. Ann Surg, 2007, 245(5): 674-683.
9.	Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis. Radiology, 1990, 174(2): 331-336.
10.	Moher D, Liberati A, Tetzlaff J. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. Open Med, 2009, 3(3): 123-130.
11.	Bradley EL III. A clinically based classi?cation system for acute pancreatitis. Summary of the International Symposiumon Acute Pancreatitis. Arch Surg, 1993, 128(5): 586-590.
12.	Toouli J, Brooke-Smith M, Bassi C, et al. Working party of the program committee of the Bangkok World Congress of Gastroenterology. Guideline for the management of acute pancreatitis. J Gastroenterol Hepatol, 2002, 17 suppl: S15-39.
13.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions 5.0.2 [updated September 2009]. The Cochrane Collaboration; 2008.
14.	Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst, 1959, 22(4): 719-748.
15.	DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials, 1986, 7(3): 177-188.
16.	Egger M, Davey SG, Schneider M. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
17.	Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994, 50(4): 1088-1101.
18.	Røkke O, Harbitz TB, Liljedal J, et al. Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial. Scand JGastroenterol, 2007, 42(6): 771-776.
19.	Yang X, Deng LH, Xue P, et al. Non-preventive use of antibiotics in patients with severe acute pancreatitis treated with integrated traditional Chinese and Western medicine therapy: a randomized controlled trial. J Chin Interg Med, 2009, 7(4): 330-333.
20.	Schwarz M, Isenmann R, Meyer H. Antibiotika bei nekrotisierender Pankreatitis. Ergebnisse einer kontrol lierten Studie. Dtsch Med Wochenschr, 1997, 122(12): 356-361.
21.	Nordback I, Sand J, Saaristo R, et al. Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis—a single-center randomized study. J Gastrointest Surg, 2001, 5(2): 113-118.
22.	Spicak J, Hubaczova M, Antos F, et al. Antibiotics in the treatment of acute pancreatitis-?ndings from a randomized multi-center prospective study. Ces Slov Gastroent Hepatol, 2002, 56(5): 183-193.
23.	Barreda L, Targarono J, Milian W, et al. the prophylactic therapy with imipenem effective for patients with pancreatic necrosis. Acta Gastro enterol Latinoam, 2009, 39(1): 24-29.
24.	Xue P, Deng LH, Zhang ZD, et al. Effect of antibiotic prophylaxis on acutenecrotizing pancreatitis: results of a randomized controlled trial. J Gastroenterol Hepatol, 2009, 24(5): 736-742.
25.	Jafri NS, Mahid SS, Idstein SR, et al. Antibiotic prophylaxis is not preventive in severe acute pancreatitis: a systematic review and meta-analysis. Am J Surg, 2009, 197(6): 806-813.
26.	Spicak J, Hejtmankova S, Hubaczova M, et al. Antibiotic prophylaxis of infectious complications of acute pancreatitis the results of a randomised study by meropenem. Ces Slov Gastroent Hepatol, 2003, 57(6): 222-227.

1. Isenmann R, Rünzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis a placebo-controlled, double-blind trial. Gastroenterology, 2004, 126(4): 997-1004.
2. Sainio V, Kemppainen E, Puolakkainen P, et al. Early antibiotic treatment in acute necrotizing pancreatitis. Lancet, 1995, 346(8976): 663-667.
3. Pederzoli P, Bassi C, Vesentini S. A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet, 1993, 176(5): 480-483.
4. Banks PA, Freeman ML. The Practice Parameters Committee of the American College of Gastroenterology: practiceguidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10): 2379-2400.
5. Garcia-Barrasa A, Borobia F, Pallares R, et al. A double-blind, placebo-controlled trial of cipro?oxacin prophylaxis in patients with acute necrotizing pancreatitis. J Gastrointest Surg, 2009, 13(4): 768-774.
6. Xong GS, Wu SM, Wang ZH. Role of ProPhylactic antibiotic administration in severe acute Pancreatitis: a meta-analysis. Med Princ Pract, 2006, 15(2): 106-110.
7. Dambrauskas Z, Gulbinas A, Pundzius J, et al. Meta-analysis of ProPhylactic Parenteral antibiotic use in acute necrotizing Panereatitis. Medicina (kaunas), 2007, 43(4): 291-300.
8. Dellinger EP, Tellado JM, Soto NE, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: randomized, double-blind placebo-controlled study. Ann Surg, 2007, 245(5): 674-683.
9. Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis. Radiology, 1990, 174(2): 331-336.
10. Moher D, Liberati A, Tetzlaff J. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. Open Med, 2009, 3(3): 123-130.
11. Bradley EL III. A clinically based classi?cation system for acute pancreatitis. Summary of the International Symposiumon Acute Pancreatitis. Arch Surg, 1993, 128(5): 586-590.
12. Toouli J, Brooke-Smith M, Bassi C, et al. Working party of the program committee of the Bangkok World Congress of Gastroenterology. Guideline for the management of acute pancreatitis. J Gastroenterol Hepatol, 2002, 17 suppl: S15-39.
13. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions 5.0.2 [updated September 2009]. The Cochrane Collaboration; 2008.
14. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst, 1959, 22(4): 719-748.
15. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials, 1986, 7(3): 177-188.
16. Egger M, Davey SG, Schneider M. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
17. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994, 50(4): 1088-1101.
18. Røkke O, Harbitz TB, Liljedal J, et al. Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial. Scand JGastroenterol, 2007, 42(6): 771-776.
19. Yang X, Deng LH, Xue P, et al. Non-preventive use of antibiotics in patients with severe acute pancreatitis treated with integrated traditional Chinese and Western medicine therapy: a randomized controlled trial. J Chin Interg Med, 2009, 7(4): 330-333.
20. Schwarz M, Isenmann R, Meyer H. Antibiotika bei nekrotisierender Pankreatitis. Ergebnisse einer kontrol lierten Studie. Dtsch Med Wochenschr, 1997, 122(12): 356-361.
21. Nordback I, Sand J, Saaristo R, et al. Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis—a single-center randomized study. J Gastrointest Surg, 2001, 5(2): 113-118.
22. Spicak J, Hubaczova M, Antos F, et al. Antibiotics in the treatment of acute pancreatitis-?ndings from a randomized multi-center prospective study. Ces Slov Gastroent Hepatol, 2002, 56(5): 183-193.
23. Barreda L, Targarono J, Milian W, et al. the prophylactic therapy with imipenem effective for patients with pancreatic necrosis. Acta Gastro enterol Latinoam, 2009, 39(1): 24-29.
24. Xue P, Deng LH, Zhang ZD, et al. Effect of antibiotic prophylaxis on acutenecrotizing pancreatitis: results of a randomized controlled trial. J Gastroenterol Hepatol, 2009, 24(5): 736-742.
25. Jafri NS, Mahid SS, Idstein SR, et al. Antibiotic prophylaxis is not preventive in severe acute pancreatitis: a systematic review and meta-analysis. Am J Surg, 2009, 197(6): 806-813.
26. Spicak J, Hejtmankova S, Hubaczova M, et al. Antibiotic prophylaxis of infectious complications of acute pancreatitis the results of a randomised study by meropenem. Ces Slov Gastroent Hepatol, 2003, 57(6): 222-227.

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《中國循證醫學雜志》

重癥急性胰腺炎預防性抗菌藥物治療的Meta分析

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