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益生菌预防机械通气患者呼吸机相关性肺炎：一项采用序贯试验分析的Meta分析

Probiotics for Preventing Ventilator-Associated Pneumonia in Mechanically Ventilated Patients: A Meta-Analysis with Trial Sequential Analysis.

作者信息

Weng Hong, Li Jian-Guo, Mao Zhi, Feng Ying, Wang Chao-Yang, Ren Xue-Qun, Zeng Xian-Tao

机构信息

Center of Evidence Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.

Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.

出版信息

Front Pharmacol. 2017 Oct 9;8:717. doi: 10.3389/fphar.2017.00717. eCollection 2017.

DOI:10.3389/fphar.2017.00717
PMID:29062279
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5640711/
Abstract

Ventilator-associated pneumonia (VAP) is still an important cause of morbidity and mortality in mechanically ventilated patients. The efficacy of the probiotics for preventing VAP is still controversial. Present study was conducted to comprehensively evaluate the effect of probiotics on VAP prevention in mechanically ventilated patients. PubMed, Embase, and CENTRAL were searched up to September 2016. Eligible trials designed with randomized controlled trials (RCTs) comparing probiotics with control in mechanically ventilated patients were included. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated with fixed or random effects models. Trial sequential analysis (TSA) was performed using TSA 0.9beta software. Thirteen RCTs ( = 1969) were included. Overall, probiotics were associated with reduced incidence of VAP (RR = 0.73, 95% CI = 0.60-0.89; = 0.002), which was confirmed by TSA (TSA adjusted 95% CI = 0.55-0.96). However, no significant difference was observed in 90-day mortality (RR = 1.00, 95% CI = 0.72-1.37; = 0.99), overall mortality (RR = 0.84, 95% CI = 0.70-1.02; = 0.09), 28-day mortality (RR = 1.06, 95% CI = 0.72-1.57; = 0.99), intensive care unit (ICU) mortality (RR = 0.97, 95% CI = 0.74-1.27; = 0.82), hospital mortality (RR = 0.81, 95% CI = 0.65-1.02; = 0.07), diarrhea (RR = 0.99, 95% CI = 0.83-1.19; = 0.92), length of ICU stay (MD = -2.40 days, 95% CI = -6.75 to 1.95; = 0.28), length of hospital stay (MD = -1.34 days, 95% CI = -6.21 to 3.54; = 0.59), and duration of mechanical ventilation (MD = -3.32 days, 95% CI = -6.74 to 0.09; = 0.06). In this meta-analysis, we found that probiotics could reduce the incidence of VAP in mechanically ventilated patients. It seems likely that probiotics provide clinical benefits for mechanically ventilated patients.

摘要

呼吸机相关性肺炎（VAP）仍然是机械通气患者发病和死亡的重要原因。益生菌预防VAP的疗效仍存在争议。本研究旨在全面评估益生菌对机械通气患者预防VAP的效果。检索了截至2016年9月的PubMed、Embase和CENTRAL数据库。纳入符合条件的随机对照试验（RCT），比较机械通气患者中益生菌与对照组的情况。采用固定或随机效应模型估计风险比（RRs）和95%置信区间（CIs）的平均差（MDs）。使用TSA 0.9beta软件进行试验序贯分析（TSA）。纳入了13项RCT（n = 1969）。总体而言，益生菌与VAP发病率降低相关（RR = 0.73，95% CI = 0.60 - 0.89；P = 0.002），TSA证实了这一点（TSA调整后的95% CI = 0.55 - 0.96）。然而，在90天死亡率（RR = 1.00，95% CI = 0.72 - 1.37；P = 0.99）、总体死亡率（RR = 0.84，95% CI = 0.70 - 1.02；P = 0.09）、28天死亡率（RR = 1.06，95% CI = 0.72 - 1.57；P = 0.99）、重症监护病房（ICU）死亡率（RR = 0.97, 95% CI = 0.74 - 1.27；P = 0.82）、医院死亡率（RR = 0.81, 95% CI = 0.65 - 1.02；P = 0.07）、腹泻（RR = 0.99, 95% CI = 0.83 - 1.19；P = 0.92）、ICU住院时间（MD = -2.40天，95% CI = -6.75至1.95；P = 0.28）、医院住院时间（MD = -1.34天，9

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