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目的基于疾病负担,循证评价与遴选我国示范乡镇卫生院治疗急性胆囊炎的基本药物。方法按本系列研究之二制定的方法、标准和流程,参考国内外循证或权威指南的推荐意见,结合国内相关临床研究及细菌耐药性证据,循证评价并推荐相关药物。主要采用RevMan 5.1、GRADEpro 3.6等软件处理数据、评价证据质量。结果①纳入指南3个(国外2个,国内1个),2个为循证制定,1个为结合专家意见制定;②治疗争性胆囊炎,2个RCT(n=200,低质量)和2个CCT(n=230,低质量)显示,氨苄西林/舒巴坦、哌拉西林/他唑巴坦、环丙沙星和头孢他啶分别联合甲硝唑的有效率为92.5%、92.6%、92.5%和91.3%。3个RCT(n=661,低质量)显示,左氧氟沙星的有效率为82.2%～95.8%,联合甲硝唑的有效率为84.4～94.7%。3个RCT(n=553,低质量)显示,头孢曲松、头孢呋辛和头孢哌酮/舒巴坦的有效率分别为90%、73.7%和95.6%,联合甲硝唑的有效率分别为93.3%,82.5%和92.3%。1个RCT(n=72,低质量)显示,头孢唑啉的有效率为70.9%,细菌耐(G+/G–)药率为70%和87%。结论①强推荐哌拉西林/他唑巴坦、头孢哌酮/舒巴坦治疗轻、中、重度急性胆囊炎;美罗培南、亚胺培南/西司他丁和甲硝唑作为重度急性胆囊炎的备选药物。②弱推荐头孢他啶、头孢吡肟治疗重度急性胆囊炎;头孢替安、氨苄西林/舒巴坦、头孢呋辛治疗轻、中度急性胆囊炎;左氧氟沙星、环丙沙星治疗轻、重度急性胆囊炎;头孢曲松治疗轻、中、重度急性胆囊炎。③不推荐头孢唑啉用于治疗急性胆囊炎。④建议尽量报道大样本对照研究,完善结局指标,以便生产高质量本土化证据。
Objective Based on the burden of disease, evidence-based evaluation and selection of our model township hospitals for the treatment of acute cholecystitis essential drugs. Methods According to the methods, standards and procedures developed in this series of studies, with reference to the recommendations of evidence-based or authoritative guidelines both at home and abroad, and with relevant clinical studies and evidence of bacterial resistance in China, evidence-based evaluation and recommendation of relevant drugs were made. The main use of RevMan 5.1, GRADEpro 3.6 software such as data processing, evaluation of evidence of quality. Results ① There were 3 guidelines (2 in foreign and 1 in domestic), 2 in evidence-based and 1 in combination with expert opinion. ② The treatment of severe cholecystitis, 2 RCTs (n = 200, low quality) and Two CCTs (n = 230, low quality) showed that the combined efficacies of ampicillin / sulbactam, piperacillin / tazobactam, ciprofloxacin and ceftazidime, respectively, were 92.5% and 92.6% 92.5% and 91.3%. Three RCTs (n = 661, low quality) showed that the effective rate of levofloxacin was 82.2% -95.8%, and the combined effective rate of metronidazole was 84.4-94.7%. Three RCTs (n = 553, low quality) showed that the effective rates of ceftriaxone, cefuroxime and cefoperazone / sulbactam were 90%, 73.7% and 95.6%, respectively, and the combined efficacies of metronidazole 93.3%, 82.5% and 92.3%. One RCT (n = 72, low quality) showed an efficacy of 70.9% for cefazolin and 70% and 87% for bacterial resistance (G + / G-). Conclusions ①Piperacillin / tazobactam and cefoperazone / sulbactam are highly recommended for the treatment of mild, moderate and severe acute cholecystitis; Meropenem, imipenem / cilastatin and metronidazole are recommended as severe acute cholecystitis Inflammation of the alternative drugs. ② weak recommendation ceftazidime, cefepime in the treatment of severe acute cholecystitis; cefotiam, ampicillin / sulbactam, cefuroxime treatment of mild to moderate acute cholecystitis; levofloxacin, ciprofloxacin in the treatment of mild and severe acute cholecystitis Ceftriaxone treatment of mild, moderate and severe acute cholecystitis. ③ cefazolin is not recommended for the treatment of acute cholecystitis. ④ It is advisable to report as large a controlled study as possible and improve the outcome indicators in order to produce high-quality indigenous evidence.