發(fā)布時(shí)間：2018-08-16 15:40

【摘要】：目的:系統(tǒng)評(píng)價(jià)局部應(yīng)用慶大霉素膠原海綿預(yù)防手術(shù)切口感染的療效,為臨床提供循證參考。方法:計(jì)算機(jī)檢索Pub Med、EMBase、Cochrane圖書館、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫、相關(guān)期刊論文、中文科技期刊數(shù)據(jù)庫、萬方數(shù)據(jù)庫收集局部應(yīng)用慶大霉素膠原海綿(試驗(yàn)組)對(duì)比常規(guī)手術(shù)處理(對(duì)照組)預(yù)防手術(shù)切口感染的隨機(jī)對(duì)照試驗(yàn)(RCT),提取資料并按照改良的Jadad量表評(píng)價(jià)質(zhì)量后,采用Rev Man 5.3統(tǒng)計(jì)軟件進(jìn)行Meta分析。結(jié)果:共納入16項(xiàng)RCT,合計(jì)7 752例患者。Meta分析結(jié)果顯示,試驗(yàn)組患者手術(shù)切口感染率顯著低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義[OR=0.71,95%CI(0.61,0.84),P0.001]。亞組分析發(fā)現(xiàn),心血管系統(tǒng)手術(shù)組患者[OR=0.59,95%CI(0.37,0.96),P=0.03]和皮膚軟組織手術(shù)組患者[OR=0.34,95%CI(0.15,0.75),P=0.008]手術(shù)切口感染率均顯著低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義;消化系統(tǒng)手術(shù)組患者手術(shù)切口感染率與對(duì)照組比較,差異無統(tǒng)計(jì)學(xué)意義[OR=0.62,95%CI(0.25,1.54),P=0.30]。術(shù)后隨訪30 d及以內(nèi)組患者手術(shù)切口感染率顯著低于對(duì)照組[OR=0.58,95%CI(0.41,0.82),P=0.002],差異均有統(tǒng)計(jì)學(xué)意義;30 d以上組患者手術(shù)切口感染率與對(duì)照組比較,差異無統(tǒng)計(jì)學(xué)意義[OR=0.86,95%CI(0.71,1.04),P=0.13]。術(shù)后植入膠原海綿含慶大霉素高劑量組(100 mg)患者手術(shù)切口感染率顯著低于對(duì)照組[OR=0.65,95%CI(0.52,0.82),P0.001],差異有統(tǒng)計(jì)學(xué)意義;低劑量組(≤100 mg)患者手術(shù)切口感染率與對(duì)照組比較,差異無統(tǒng)計(jì)學(xué)意義[OR=0.96,95%CI(0.72,1.28),P=0.77]。結(jié)論:局部應(yīng)用慶大霉素膠原海綿可能對(duì)預(yù)防手術(shù)感染有一定作用,并且不同的手術(shù)類型、觀察時(shí)間和慶大霉素使用劑量的預(yù)防效果有差異,臨床應(yīng)結(jié)合實(shí)際謹(jǐn)慎使用。
[Abstract]:Objective: to evaluate the efficacy of local application of gentamicin collagen sponge in the prevention of surgical incision infection. Methods: a computerized search was conducted for the Pub Medtrol EMBase Cochrane Library, the Chinese Biomedical Literature Database, the Chinese Journal Full-text Database, and the Chinese Sci-tech Journal Database. Wanfang database collected local application of gentamicin collagen sponge (trial group) for the prevention of surgical incision infection compared with conventional surgical treatment (control group) of randomized controlled trial (RCT), extraction data and evaluate the quality according to the modified Jadad scale. Meta analysis was carried out with Rev Man 5.3 statistical software. Results: a total of 16 RCTs were included. The results of Meta-analysis showed that the infection rate of surgical incision in the trial group was significantly lower than that in the control group (P 0.001). The results of subgroup analysis showed that the incision infection rate in the cardiovascular system operation group [ORO 0.59 鹵9595 CI (0.37 鹵0.96) P0. 03] and the skin and soft tissue operation group [ORG 0.34 95 CI (0. 15 + 0. 75) P 0. 008] was significantly lower than that in the control group (P 0. 008, P 0. 008). The infection rate of surgical incision in the digestive system operation group was not significantly different from that in the control group [ORO 0.62 鹵95 CI (0.25 鹵1.54) P < 0.30]. The infection rate of surgical incision in the patients within 30 days after operation was significantly lower than that in the control group [ORO 0.5895 CI (0.41U 0.82) P 0.002]. There was no significant difference in the infection rate of surgical incision between the patients of the group over 30 days after operation and the control group [OR0.86 + 95CI (0.711.04) P 0.13]. The operative incision infection rate in the high dose group (100 mg) with collagen sponge implantation was significantly lower than that in the control group [ORO 0.65J 95 CI (0.52U 0.82) P 0.001], and the infection rate in the low dose group (鈮，

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