雾化吸入抗生素对预防重症患者呼吸机相关性肺炎的影响：一项系统评价和荟萃分析。
Effect of nebulised inhalation of antibiotics on preventing ventilator-associated pneumonia in critically ill patients: a systematic review and meta-analysis.
作者信息
Yuan Xiang, Feng Yuning, Wan Jun, Zhang Sen, Bao Qingyu, Liu Xin, Shen Yihong, Deng Yongjie, Chen Xian, Jiang Xinyi, Li Huixuan, Liu Qian, Zeng Jingyao, Zhang Yu
机构信息
Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
Northeast Normal University, Changchun, Jilin, China.
出版信息
BMJ Open. 2025 May 31;15(5):e093868. doi: 10.1136/bmjopen-2024-093868.
OBJECTIVE
To investigate whether prophylactic nebulised antibiotic inhalation reduces the incidence of ventilator-associated pneumonia (VAP) in critically ill adults undergoing mechanical ventilation.
STUDY DESIGN
Systematic review and meta-analysis of randomised controlled trials.
DATA SOURCES
PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched from inception to 1 January 2024 without language restrictions.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
We included randomised controlled trials comparing prophylactic nebulised antibiotics with placebo or no treatment in mechanically ventilated adult intensive care unit (ICU) patients. Two independent reviewers conducted data extraction and assessed risk of bias. A meta-analysis was performed using random-effects models to calculate relative risks (RRs) for VAP and secondary outcomes.
RESULTS
Of the 2663 studies screened, four were deemed suitable for analysis, involving a total of 1160 patients (574 receiving prophylactic antibiotics via nebulised inhalation). Nebulised antibiotics reduced the incidence of VAP compared with control (RR 0.70, 95% CI 0.52 to 0.93, I²=38%, low-certainty). There were no statistically significant differences in ICU mortality (RR 0.89, 95% CI 0.73 to 1.09, I²=0%, low-certainty, moderate-certainty) or hospital mortality (RR 0.93, 95% CI 0.78 to 1.11, I²=0%, moderate-certainty). Risk of bias varied across studies, with one trial assessed as high risk, one with some concerns and two with low risk.
CONCLUSIONS
Nebulised prophylactic antibiotics may reduce the incidence of VAP in critically ill patients receiving mechanical ventilation, though secondary outcomes did not differ between the intervention and control groups. The findings should be interpreted with caution due to the small number of included trials and low certainty of evidence.
PROSPERO REGISTRATION NUMBER
CRD42024496276.
目的
探讨预防性雾化吸入抗生素是否能降低接受机械通气的重症成年患者呼吸机相关性肺炎（VAP）的发生率。
研究设计
对随机对照试验进行系统评价和荟萃分析。
数据来源
检索了PubMed、Embase和Cochrane对照试验中心注册库，检索时间从建库至2024年1月1日，无语言限制。
选择研究的纳入标准
我们纳入了比较预防性雾化抗生素与安慰剂或不治疗的随机对照试验，试验对象为接受机械通气的成人重症监护病房（ICU）患者。两名独立的评价者进行数据提取并评估偏倚风险。使用随机效应模型进行荟萃分析，以计算VAP和次要结局的相对风险（RR）。
结果
在筛查的2663项研究中，4项被认为适合分析，共涉及1160例患者（574例通过雾化吸入接受预防性抗生素治疗）。与对照组相比，雾化抗生素降低了VAP的发生率（RR 0.70，95%CI 0.52至0.93，I²=38%，低确定性）。ICU死亡率（RR 0.89，95%CI 0.73至1.09，I²=0%，低确定性、中度确定性）或医院死亡率（RR 0.93，95%CI 0.78至1.11，I²=0%，中度确定性）无统计学显著差异。各研究的偏倚风险各不相同，一项试验被评估为高风险，一项存在一些担忧，两项为低风险。
结论
预防性雾化抗生素可能会降低接受机械通气的重症患者VAP的发生率，尽管干预组和对照组的次要结局没有差异。由于纳入试验数量少且证据确定性低，这些结果应谨慎解释。
PROSPERO注册号：CRD42024496276。
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