Meta分析重症急性胰腺炎预防性使用抗生素的作用

摘要

Objective To investigate whether prophylactic use of antibiotics is effiective for pa-tients with severe acute pancreatitis. Method Related literature published in all prophylactic an-tibiotic treatment of severe acute pancreatitis from January 1990 to May 2013 on MEDLINE, CNKI, WILLEY database were retrieved and evMand5.0 software were used for analysis. Result Eventually 12 randomized controlled trials of 718 patients were included in the Meta analysis, in which 356 cases of antibiotic prophylaxis group and 362 cases of control group. Prophylactic use of antibiotics in the treatment of acute necrotizing pancreatitis was compared with the control group, it did not significantly improve survival(RR 0.78,95% CI 0.53~1.15,P=0.20), did not reduce pancreatic infection (RR 0.77,95% CI occurred 0.58~1.02,P=0.07), pancreatic infection (RR 0.72,95% CI 0.49~1.06, P= 0.09) and surgical interventions (RR 0.90,95% CI 0.67~1.19,P= 0.45) and other complications odds. Conclusion Prophylactic antibiotic treatment did not reduce mortal-ity in patients with severe acute pancreatitis and had no significant protective effect in patients with SAP.%目的：探讨预防性使用抗生素治疗重症急性胰腺炎是否有益。方法在MEDLINE、CNKI、WILLEY数据库上检索1990年1月~2013年5月发表的所有预防性使用抗生素治疗急性重症胰腺炎的相关文献，使用RevMand5.0软件进行分析。结果最终有12个随机对照试验共718例患者纳入Meta分析,其中预防性抗生素组356例,对照组362例。预防性使用抗生素治疗急性坏死性胰腺炎与对照组相比，并不能显著改善生存率(RR 0.78，95%CI 0.53～1.15，P=0.20),也不能降低胰腺感染(RR 0.77，95%CI 0.58～1.02，P=0.07)、胰外感染(RR 0.72，95%CI 0.49～1.06，P=0.09)及手术干预(RR 0.90，95%CI 0.67～1.19，P=0.45)等并发症的发生几率。结论预防性使用抗生素不能降低急性重症胰腺炎患者的死亡率，对SAP患者无明显保护作用。