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万古霉素持续输注与间歇输注有效性与安全性比较的Meta分析
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| 篇名： | 万古霉素持续输注与间歇输注有效性与安全性比较的Meta分析 |
| TITLE： | Efficacy and Safety of Vancomycin Given by Continuous Infusion vs. Intermittent Infusion ：A Meta-analysis |
| 摘要： | 目的：比较万古霉素持续输注和间歇输注的有效性和安全性，为临床用药提供循证参考。方法：计算机检索PubMed、Cochrane图书馆、Embase、万方数据、中国知网、维普网等数据库，收集万古霉素持续输注（试验组）对比间歇输注（对照组）的随机对照研究（RCT）和队列研究，检索时限均为建库起至2020年4月。筛选文献、提取资料后，采用Cochrane系统评价员手册6.0推荐的偏倚风险评估工具对RCT进行质量评价，采用纽卡斯尔-渥太华量表对队列研究进行质量评价；采用RevMan5.3软件进行Meta分析和发表偏倚分析。结果：共纳入20项研究（3项为RCT、17项为队列研究），共计2380例患者。Meta分析结果显示，试验组患者的目标浓度达标率[RR＝1.24，95％CI（1.12，1.38），P＜0.0001]、临床疗效靶值达标率[RR＝1.20，95％CI（1.04，1.38），P＝0.01]均显著高于对照组，肾毒性发生率[RR＝0.56，95％CI（0.45，0.70），P＜0.00001]显著低于对照组；两组患者的治疗有效率[RR＝1.02，95％CI（0.95，1.10），P＝0.53]、用药时间[MD＝－0.50，95％CI（－1.40，0.39），P＝0.27]、病死率[RR＝1.03，95％CI（0.78，1.35），P＝0.83]比较，差异均无统计学意义。发表偏倚结果显示，以肾毒性发生率为指标时存在发表偏倚的可能性较大。结论：万古霉素持续输注能提高患者目标浓度达标率和临床疗效靶值达标率，降低肾毒性发生率，但不能提高治疗有效率；由于发表偏倚结果不一致，故上述结论需谨慎解读。 |
| ABSTRACT： | OBJECTIVE：To compare the efficacy and safety of vancomycin given by continuous infusion vs. intermittent infusion，and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from PubMed ，the Cochrane Library，Embase，Wanfang database ，CNKI and VIP databases ，ranomized controlled trials （RCT）and cohort studies about vancomycin given by continuous infusion （trial group ）vs. intermittent infusion （control group ）were collected during the inception to Apr. 2020. After literature screening and data extraction ，the qualities of RCTs were evaluated by using bias risk evaluation tool recommended by Cochrane system evaluator manual 6.0. The qualities of cohort studies were evaluated by NOS ；Rev Man 5.3 software was used to perform Meta-analysis and publication bias analysis. RESULTS ：A total of 20 studies were included （3 RCTs and 17 cohort studies ），involving 2 380 patients in total. Results of Meta-analysis showed that ，target concentration attainment rate [RR ＝1.24，95％CI（1.12，1.38），P＜0.000 1] and attainment rate of target clinical efficacy [RR ＝1.20，95％CI（1.04，1.38）， P＝0.01] of trial group was significantly higher than those of control group. The incidence of nephrotoxicity [RR ＝0.56，95％CI （0.45，0.70），P＜0.000 01] was significantly lower than control group. There was no statistical significance in the therapeutic efficiency [RR ＝1.02，95％CI（0.95，1.10），P＝0.53]，drug treatment duration [MD ＝－0.50，95％CI（－1.40，0.39），P＝0.27] or mortality [RR ＝1.03，95％CI（0.78，1.35），P＝0.83] between 2 groups. The results of publication bias showed that the probability of publication bias was high when the incidence of nephrotoxicity was used as the index. CONCLUSIONS ：Vancomycin continuous infusion can improve the attainment rate of target concentration and target clinical efficacy ，reduce the incidence of nephrotoxicity ， but can not improve the treatment efficiency. Due to the inconsistent results of publication bias analysis ，the above conclusion needs to be interpreted carefully. |
| 期刊： | 2020年第31卷第22期 |
| 作者： | 刘露，吴知桂，范清泽，叶云，罗宏丽 |
| AUTHORS： | LIU Lu，WU Zhigui ，FAN Qingze ，YE Yun，LUO Hongli |
| 关键字： | 万古霉素；持续输注；间歇输注；疗效；安全性；Meta分析 |
| KEYWORDS： | Vancomycin；Continuous infusion ；Intermittent infusion ；Efficacy；Safety；Meta-analysis |
| 阅读数： | 401 次 |
| 本月下载数： | 11 次 |
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