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目的系统性评价降钙素原(PCT)导向的抗生素使用对重症患者抗感染疗程、抗生素不良反应及临床预后的影响。方法计算机检索和手工检索收集有关PCT指导重症患者抗感染治疗的原始研究文献,按纳入与排除标准选择文献,评价纳入文献质量,提取资料,采用Rev Man 5.3软件对数据进行Meta分析。结果共纳入8篇文献,全部为随机对照临床试验(RCT)研究。8篇研究共入选2 708例患者,其中PCT导向组1 360例,经验性使用组1 348例。Meta分析显示,与经验性使用组相比,PCT导向组抗生素疗程明显缩短[平均差(MD)=-2.44,95%可信区间(95%CI)-3.25~-1.62,P<0.000 01];且PCT导向组抗生素不良反应发生率显著降低[相对危险度(RR)=0.74,95%CI 0.56~0.97,P=0.03],但PCT导向组患者病死率并无显著下降[RR=1.00,95%CI 0.89~1.13,P=0.99]。结论与经验性使用抗生素相比,PCT导向的抗感染方案可以显著缩短重症患者抗生素疗程,降低抗生素不良反应发生率,但对重症患者的病死率无明显影响。
Objective To systematically evaluate the effects of procatercalcium-induced antibiotic therapy on anti-infective therapy, adverse reactions of antibiotics and clinical prognosis in critically ill patients. METHODS: Computer-based searches and manual searches were performed to collect original research literature on PCT-directed anti-infective therapy in critically ill patients. Literature was selected on inclusion and exclusion criteria, and quality of literature included, data extracted, and Meta-analysis of data using Rev Man 5.3 software. Results A total of eight articles were included, all of which were randomized controlled clinical trials (RCTs). Eight studies enrolled 2 708 patients, of whom 1,360 were in the PCT-guided group and 1,348 in the empiric group. Meta-analysis showed a significantly shorter course of antibiotic treatment in the PCT-guided group compared with the empirically used group (mean difference (MD) = -2.44, 95% confidence interval -3.25 to -1.62, P <0.000 01] (RR = 0.74, 95% CI 0.56-0.97, P = 0.03). However, there was no significant reduction in the incidence of adverse reactions in PCT-guided patients (RR = 1.00, 95% CI 0.89-1.13, P = 0.99]. Conclusion Compared with the empirical antibiotics, PCT-directed anti-infective program can significantly shorten the course of antibiotics in critically ill patients and reduce the incidence of adverse reactions of antibiotics, but have no significant effect on the mortality of critically ill patients.