Kollef M H
Department of Internal Medicine, Washington University School of Medicine, St. Louis.
Chest. 1994 Apr;105(4):1101-8. doi: 10.1378/chest.105.4.1101.
To review available clinical trials of selective digestive decontamination (SDD) in patients requiring intensive care.
All relevant English-language articles from 1982 through 1992 were identified through MEDLINE search and article bibliographies.
Twenty-one articles were identified; 16 articles were selected for analysis based on inclusion and exclusion criteria.
Occurrence rates for mortality, acquired pneumonia, and acquired tracheobronchitis were extracted for patients treated with SDD and for control patients. Cumulative risk differences were calculated for each of these outcomes.
There was no significant difference between cumulative mortality rates for control patients (0.262; n = 1,165) and patients receiving SDD (0.243; n = 1,105) (p = 0.291; beta error rate = 0.16). The acquired pneumonia greater than that in patients receiving SDD (0.074; n = 1,031) (p < 0.0001). The acquired tracheobronchitis rate in control patients (0.117; n = 549) was also significantly greater than that in patients receiving SDD (0.065; n = 494) (p = 0.004). The rate of acquired pneumonia due to Gram-positive bacteria was similar between the control patients (0.033; n = 660) and the SDD-treated patients (0.033; n = 646) (p = 0.933). Colonization with pathogenic Gram-positive bacteria and pneumonia due to antibiotic-resistant Gram-positive bacteria appeared to occur more frequently in SDD-treated patients.
These results suggest that SDD decreases the overall incidence of acquired pneumonia and tracheobronchitis in patients requiring intensive care. SDD had no apparent effect on the hospital mortality rate. The routine use of SDD cannot be supported by this meta-analysis. SDD may be useful in specific circumstances where a particular ICU or ICU population is found to have an excessive incidence of acquired infections. Any use of SDD should include careful patient surveillance for the emergence of infection due to bacteria not covered by the prophylaxis regimen and due to antibiotic-resistant bacteria.
回顾针对需要重症监护的患者进行选择性消化道去污（SDD）的现有临床试验。
通过医学文献数据库（MEDLINE）检索以及文章参考文献，识别出了1982年至1992年期间所有相关的英文文章。
共识别出21篇文章；根据纳入和排除标准，选取了16篇文章进行分析。
提取接受SDD治疗的患者和对照患者的死亡率、获得性肺炎发生率以及获得性气管支气管炎发生率。计算这些结果各自的累积风险差异。
对照患者（0.262；n = 1165）和接受SDD治疗的患者（0.243；n = 1105）的累积死亡率之间无显著差异（p = 0.291；Ⅱ类错误率 = 0.16）。对照患者的获得性肺炎发生率（0.074；n = 1031）显著高于接受SDD治疗的患者（p < 0.0001）。对照患者的获得性气管支气管炎发生率（0.117；n = 549）也显著高于接受SDD治疗的患者（0.065；n = 494）（p = 0.004）。对照患者（0.033；n = 660）和接受SDD治疗的患者（0.033；n = 646）因革兰氏阳性菌引起的获得性肺炎发生率相似（p = 0.933）。接受SDD治疗的患者中，致病性革兰氏阳性菌定植以及由耐抗生素革兰氏阳性菌引起的肺炎似乎更频繁发生。
这些结果表明，SDD可降低需要重症监护的患者获得性肺炎和气管支气管炎的总体发生率。SDD对医院死亡率无明显影响。该荟萃分析不支持常规使用SDD。在特定的重症监护病房（ICU）或ICU人群中发现获得性感染发生率过高的特定情况下，SDD可能有用。SDD的任何使用都应包括仔细监测患者，以防出现由预防方案未覆盖的细菌以及耐抗生素细菌引起的感染。
