CAJ | 학술논문

目的分析预防性抗生素能否降低术前为清洁尿、行经皮肾镜取石术(PCNL)患者术后感染性并发症的风险.方法制定原始文献的纳入标准、排除标准及检索策略,在美国医学索引(1966年1月至2013年2月)、荷兰医学文摘(1988年1月至2013年2月)、Cochrane图书馆、中国生物医学期刊文献数据库(1979年至2013年2月)、中国知网数字图书馆(1979年1月至2013年2月)进行相关的随机对照试验(RCT)的检索、评价和资料提取,采用RevMan 4.2软件进行meta分析.结果共检索到相关RCT文献33篇,排除24篇,符合纳入标准的9篇.meta分析结果表明,术前清洁尿的患者预防性使用抗生素能显著降低PCNL术后l周内发热(RR =0.71,95％ CI:0.54 ～0.92,P =0.009)、菌尿(RR =0.39,95％ CI:0.23 ～0.67,P=0.0006)和菌血症(RR =0.43,95％ CI:0.25 ～0.73,P=0.002)的风险；喹诺酮可明显降低术后菌尿的风险(RR=0.31,95％ CI:0.12 ～0.82,P=0.010),硝基呋喃可降低术后发热的风险(RR =0.38,95％ CI:0.24～0.61,P=0.005)；长疗程预防应用抗生素能降低术后发热(RR =0.64,95％ CI:0.47 ～0.87,P=0.004)和菌尿(RR =0.35,95％ CI:0.18 ～0.71,P=0.003)的风险.结论术前为清洁尿的患者预防性应用抗生素能降低PCNL术后感染性并发症的风险；喹诺酮能明显降低PCNL术后发生菌尿的危险；长疗程预防抗生素能降低术后发热和菌尿的风险.
목적 분석예방성항생소능부강저술전위청길뇨、행경피신경취석술(PCNL)환자술후감염성병발증적풍험.방법 제정원시문헌적납입표준、배제표준급검색책략,재미국의학색인(1966년1월지2013년2월)、하란의학문적(1988년1월지2013년2월)、Cochrane도서관、중국생물의학기간문헌수거고(1979년지2013년2월)、중국지망수자도서관(1979년1월지2013년2월)진행상관적수궤대조시험(RCT)적검색、평개화자료제취,채용RevMan 4.2연건진행meta분석.결과 공검색도상관RCT문헌33편,배제24편,부합납입표준적9편.meta분석결과표명,술전청길뇨적환자예방성사용항생소능현저강저PCNL술후l주내발열(RR =0.71,95％ CI:0.54 ～0.92,P =0.009)、균뇨(RR =0.39,95％ CI:0.23 ～0.67,P=0.0006)화균혈증(RR =0.43,95％ CI:0.25 ～0.73,P=0.002)적풍험；규낙동가명현강저술후균뇨적풍험(RR=0.31,95％ CI:0.12 ～0.82,P=0.010),초기부남가강저술후발열적풍험(RR =0.38,95％ CI:0.24～0.61,P=0.005)；장료정예방응용항생소능강저술후발열(RR =0.64,95％ CI:0.47 ～0.87,P=0.004)화균뇨(RR =0.35,95％ CI:0.18 ～0.71,P=0.003)적풍험.결론 술전위청길뇨적환자예방성응용항생소능강저PCNL술후감염성병발증적풍험；규낙동능명현강저PCNL술후발생균뇨적위험；장료정예방항생소능강저술후발열화균뇨적풍험.
Objective To determine whether antibiotic prophylaxis can reduce the risk of postoperative infective complications in patients undergoing percutaneous nephrolithotomy (PCNL) who have sterile preoperative urine.Methods MEDLINE,EMBASE,Cochrane Collaboration Reviews,CMCC and CNKI were searched for RCTs comparing antibiotic prophylaxis with placebo (or blank controls) for patients undergoing PCNL with preoperative sterile urine.The search strategy was made according to the Collaborative Review Group search strategy.Data were extracted by 2 reviewers using the designed extraction form.The software RevMan 4.2 was used to review management and data analysis.Results A total of 9 trails,1 placebo controlled,3 non treatment controlled,and 5 active controlled,involving 1018 patients,met the inclusion criteria.Prophylactic antibiotic use in patients at low risk undergoing PCNL significantly decreased fever (RR=0.71,95％ CI:0.54-0.92,P=0.009),bacteriuria (RR =0.39,95％CI:0.23-0.67,P=0.0006) and bacteremia incidence (RR =0.43,95％ CI:0.25-0.73,P =0.002).Effective antibiotic classes included quinolone which significantly decreased bacteriuria incidence (RR =0.31,95％ CI:0.12-0.82,P =0.010) and nitrofurantoin which significantly decreased fever incidence (RR =0.38,95％ CI:0.24-0.61,P =0.005).Extended course significantly decreased fever incidence (RR =0.64,95％ CI:0.47-0.87,P =0.004) and bacteriuria incidence (RR =0.35,95％ CI:0.18-0.71,P =0.003).Conclusions Prophylactic antibiotics can significantly decrease the incidence of postoperative infective complications.A significant decrease in bacteriuria incidence can be achieved with quinolones.Extended course is effective in decreasing fever,and bacteriuria incidence.