目标导向治疗对高风险外科手术患者术后感染影响的Meta分析.doc

目标导向治疗对高风险外科手术患者术后感染影响的Meta分析 王爱田 刘芳 么改琦 朱曦 摘要 目的 系统评价目标导向治疗（Goal-directed therapy,GDT）对外科高风险患者术后感染发生率的影响。方法 通过检索美国《医学索引》（MEDLINE）、Cochrane临床试验数据库、生物医学与药理学文摘数据库P=0.02），各试验组间统计学无异质性(P0.1, I250% )；总感染率显著降低（OR=0.37, 95%CI .22~0.61, P0.00001） 结论 早期应用血流动力学目标指导性治疗能降低外科高风险患者的医院获得性感染。 关键词: 目标导向治疗；外科；术后感染；随机对照试验；系统评价 The effect of goal-directed therapy on postoperative infections in high risk surgical patients : a Meta analysis WANG Ai Tian, LIU Fang, YAO Gai Qi , ZHU Xi,. Intensive Care Unit, the Third Hospital, Beijing University, Beijing 100191,China Corresponding author: Yao Gai Qi, Email:yaogaiqi@ Abstract Objective To determine the effects of perioperative hemodynamic goal directed therapy (GDT) on postoperative infection rates Methods We conducted a systematic review and meta-analysis. MEDLINE, the Cochrane Library, EMBASE, CNKI and other sources were searched until March 2011.All randomized controlled trials (RCTs) on adult major surgical patients managed with perioperative GDT or according to routine haemodynamic practice were included. Primary outcome measure was specific for type of infection. Two authors independently extracted data ————— 作者单位：100191 北京大学第三医院ICU（王爱田（现在开滦集团有限责任公司医院 ICU工作），幺改琦，朱曦）；药剂科（刘芳） 作者简介：王爱田，女，主治医师，硕士研究生，研究方向：危重病基础与临床研究，电话 Email:wangaitian888@163.com 通信作者：么改琦，电话Email:yaogaiqi@ and assessed study quality using standardized instruments; consensus was reached by conference. The Cochrance Collaboration’s software RevMan 5.0 was used for data analysis. Results Sixteen studies were included in the final analysis, providing a sample of 3309 patients. Perioperative GDT significantly reduced surgical site infections (SSI) (OR = 0. 0.60; 95% CI 0.46-0.74; P0.0001), pneumonia (OR = 0.69; 95% CI 0.53-0.90;P=0.007), and urinary tract infections (UTIs) (OR = 0.44; 95% CI 0.22-0.88; P=0.02), and heterogeneity was minimal (p0.1, I250%). A significant benefit on total infectious episodes emerged (OR = 0.37; 95% CI 0.22-0.61; P0.