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目的系统评价抗生素治疗呼吸机相关性气管支气管炎(VAT)的疗效。方法对Pubmed、Web of Science、OVID(ACP Journal Club、Cochrane临床试验中心数据库、Embase和Medline)、CNKI、VIP、万方数据库等数据库进行抗生素治疗VAT相关的文献检索,检索截止时间为2016年3月。采用Rev Man 5.3软件对数据进行Meta分析。结果共纳入6篇研究,包括769例患者,其中使用抗生素治疗组患者为432例,未使用抗生素治疗组患者为337例。Meta分析结果显示,两组间呼吸机相关性肺炎(VAP)发生率[OR=0.27,95%CI(0.17,0.43),P<0.05]、ICU住院时间[MD-1.51,95%CI(-2.04,-0.98),P<0.000 01]差异具有统计学意义,但机械通气时间[MD-2.52,95%CI(-6.85,1.81),P=0.25]、死亡率[OR=0.41,95%CI(0.15,1.14),P=0.09]和耐药菌产生情况[OR=0.62,95%CI(0.17,2.19),P>0.05]差异无统计学意义。结论 VAT患者使用抗生素治疗能显著降低VAP的发生率,但Meta分析结果仍需更多高质量随机对照试验进行验证。
Objective To evaluate the efficacy of antibiotics in the treatment of ventilator-associated bronchitis (VAT). Methods The VAT-related literature search of Pubmed, Web of Science, OVID (ACP Journal Club, Cochrane Central Register of Clinical Trials Database, Embase and Medline), CNKI, VIP, Wanfang database was conducted with the deadline of 2016.3 month. Meta-analysis was performed using Rev Man 5.3 software. Results Six studies were included, including 769 patients, of whom 432 were treated with antibiotics and 337 were not treated with antibiotics. Meta-analysis showed that the incidence of ventilator-associated pneumonia (VAP) was significantly different between the two groups (OR = 0.27, 95% CI 0.17, 0.43; P 0. 05), ICU length of stay [MD 1.51, 95% CI (OR = 0.41, 95% CI: -6.85, 1.81, P = 0.25], and the mortality rate [OR = 0.41, 95% CI (0.15,1.14), P = 0.09], and the emergence of drug-resistant bacteria [OR = 0.62,95% CI (0.17,2.19), P> 0.05]. Conclusion The use of antibiotics in patients with VAT can significantly reduce the incidence of VAP, but the results of the meta-analysis still need more high-quality randomized controlled trials to verify.