选择性肠道净化对肝移植术后感染影响的系统评价

Systematic Evaluation of the Effect of Selective Bowel Decontamination on Infections in Liver Transplant Recipients

关键词:  选择性肠道净化  肝移植  感染  Meta分析

Key words:  selective bowel decontamination(SBD)  liver transplantation  infection  Meta-analysis

摘要:

目的 系统评价选择性肠道净化对肝移植患者术后感染的影响。方法 计算机检索PubMed、EMbase、Cochrane图书馆临床对照试验资料库、CBM、CNKI、维普和万方数据库，检索时间均从建库至2012年12月，手工检索相关文献。收集评价选择性肠道净化对肝移植患者术后感染影响的随机对照试验(RCT)。对符合纳入标准的临床研究进行质量评价和资料提取后，采用RevMan 5.1软件进行Meta分析。结果 共纳入6个RCT，包括325例患者。Meta分析结果显示，与对照组(安慰剂、制霉菌素和没有任何干预措施)相比，①选择性肠道净化能有效减少肝移植患者术后Gó细菌感染率[RR=0.25，95%CI (0.13, 0.45)，P<0.000 01]，但不能减少细菌总感染率；②在细菌感染部位方面，选择性肠道净化能有效减少肝移植患者术后的肺炎发生率[RR=0.33，95%CI(0.13, 0.83)，P=0.02]，而在其他部位(手术切口、腹部、泌尿道、血液)均未能减少细菌感染率；③选择性肠道净化能有效减少肝移植患者术后的真菌感染率[RR=0.47，95%CI(0.25，0.89)，P=0.02]；④选择性肠道净化对肝移植患者术后总死亡率影响的差异无统计学意义。结论 应用选择性肠道净化有益于减少肝移植患者术后Gó细菌感染率、肺炎感染率及真菌感染率，建议应于术前≥3 d应用至术后≥5 d，口服，4 次·d^-1。

Abstract:

OBJECTIVE To assess the effect of selective bowel decontamination(SBD) on infections in liver transplant recipients. METHODS PubMed, EMbase, Central Register of Controlled Trials, CBM, CNKI, Weipu and Wanfang Database from the date of establishment until December 2012 were searched, and hand searched relevant journals. Randomized controlled trials(RCTs) that evaluated the effects of SBD on infections in liver transplant recipients were collected. Data were extracted independently by two reviewers. Statistical analysis was performed with RevMan 5.1. RESULTS Six RCTs involving 325 patients were included. The results of Meta-analyses showed the following: ①SBD group were more effective than the control group(placebo, nystatin and no interventions) in decreasing incidence of gram-negative bacterial infection[RR=0.25, 95%CI(0.13, 0.45), P<0.000 01]. While there was no significant difference between the two groups in incidence of all bacterial infections; ②SBD group statistically significantly decreased incidence of pneumonia[RR=0.33, 95%CI(0.13, 0.83), P=0.02] than the control group. While there was no significant difference between the two groups in incidence of bacterial infection for other sites(surgical wound, abdomen, urinary tract and bloodstream); ③SBD group statistically significantly decreased incidence of fungal infection[RR=0.47, 95%CI(0.25, 0.89)，P=0.02] than the control group；④There was no significant difference between the two groups in incidence of all mortality. CONCLUSION SBD has significant benefits in the reduction of gram-negative bacterial infection, pneumonia and fungal infection. Dosage regimen: receiving the SBD regimen from ≥3 d before transplantation to ≥5 d after transplantation, po, qid.