【推荐】柳叶刀，BMJ发表综述：口腔清洁预防呼吸机肺炎的系统评价

蓝鱼o_0

Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis.Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI.
SourceFaculty of Healthcare Vesalius, University College Ghent, Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

Lancet Infect Dis. 2011 Nov;11(11):845-54. Epub 2011 Jul 26.

AbstractBACKGROUND: We did a systematic review and random effects meta-analysis of randomised trials to assess the effect of oral care with chlorhexidine or povidone-iodine on the prevalence of ventilator-associated pneumonia versus oral care without these antiseptics in adults.

我们开张了一项随机对照实验的META分析，以估计成年人口腔洗必泰或者碘伏处理预防呼吸机肺炎的效果。
METHODS: Studies were identified through PubMed, CINAHL, Web of Science, CENTRAL, and complementary manual searches. Eligible studies were randomised trials of mechanically ventilated adult patients receiving oral care with chlorhexidine or povidone-iodine. Relative risks (RR) and 95% CIs were calculated with the Mantel-Haenszel model and heterogeneity was assessed with the I(2) test.
通过PUBMED，CINAHL，科学网，CENTRAL和手工检索所需文献。用RR和95%CI表示危险度，并通过MH分层和异质性检验来估计。
FINDINGS: 14 studies were included (2481 patients), 12 investigating the effect of chlorhexidine (2341 patients) and two of povidone-iodine (140 patients). Overall, antiseptic use resulted in a significant risk reduction of ventilator-associated pneumonia (RR 0.67; 95% CI 0.50-0.88; p=0.004). Chlorhexidine application was shown to be effective (RR 0.72; 95% CI 0.55-0.94; p=0.02), whereas the effect resulting from povidone-iodine remains unclear (RR 0.39; 95% CI 0.11-1.36; p=0.14). Heterogeneity was moderate (I(2)=29%; p=0.16) for the trials using chlorhexidine and high (I(2)=67%; p=0.08) for those assessing povidone-iodine use. Favourable effects were more pronounced in subgroup analyses for 2% chlorhexidine (RR 0.53, 95% CI 0.31-0.91), and in cardiosurgical studies (RR 0.41, 95% CI 0.17-0.98).

14篇研究被纳入，累计病例2481例病患。1212个调查了洗必泰的效果，2篇调查了碘伏的效果。总体而言，运用洗必泰或者碘伏消毒可以显著降低呼吸机肺炎的发病风险(RR 0.67; 95% CI 0.50-0.88; p=0.004)。洗必泰应用被认为是显著的保护效应。但是碘伏的效应却并不明显。本研究并未检验出有显著性差异的异质性，P=0.16.分层分析显示，运用2%的洗必泰和在心脏手术的病患中，这种保护效果更为显著。

评论：这里可以看出，碘伏也是可以降低VAP的发病风险，但是因为样本量太少，仅仅有2篇，所以并没有显示出有统计学意义的差异。但是这是个很好的课题。希望有兴趣的临床医生，能够开展这项随机对照实验。以验证PI的效果。

INTERPRETATION: This analysis showed a beneficial effect of oral antiseptic use in prevention of ventilator-associated pneumonia. Clinicians should take these findings into account when providing oral care to intubated patients.
FUNDING: None.

我们的结果显示，运用口腔消毒可以显著降低VAP发病风险。对于插管的病人，临床医生应该考虑我们的研究结论。

蓝鱼o_0

Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis.Chan EY, Ruest A, Meade MO, Cook DJ.

BMJ. 2007 Apr 28;334(7599):889. Epub 2007 Mar 26.

SourceDepartment of Nursing Services, Tan Tock Seng Hospital, Singapore. ee_yuee_chan@ttsh.com.sg

AbstractOBJECTIVE: To evaluate the effect of oral decontamination on the incidence of ventilator associated pneumonia and mortality in mechanically ventilated adults.
DESIGN: Systematic review and meta-analysis.
DATA SOURCES: Medline, Embase, CINAHL, the Cochrane Library, trials registers, reference lists, conference proceedings, and investigators in the specialty.
REVIEW METHODS: Two independent reviewers screened studies for inclusion, assessed trial quality, and extracted data. Eligible trials were randomised controlled trials enrolling mechanically ventilated adults that compared the effects of daily oral application of antibiotics or antiseptics with no prophylaxis.
RESULTS: 11 trials totalling 3242 patients met the inclusion criteria. Among four trials with 1098 patients, oral application of antibiotics did not significantly reduce the incidence of ventilator associated pneumonia (relative risk 0.69, 95% confidence interval 0.41 to 1.18). In seven trials with 2144 patients, however, oral application of antiseptics significantly reduced the incidence of ventilator associated pneumonia (0.56, 0.39 to 0.81). When the results of the 11 trials were pooled, rates of ventilator associated pneumonia were lower among patients receiving either method of oral decontamination (0.61, 0.45 to 0.82). Mortality was not influenced by prophylaxis with either antibiotics (0.94, 0.73 to 1.21) or antiseptics (0.96, 0.69 to 1.33) nor was duration of mechanical ventilation or stay in the intensive care unit.
CONCLUSIONS: Oral decontamination of mechanically ventilated adults using antiseptics is associated with a lower risk of ventilator associated pneumonia. Neither antiseptic nor antibiotic oral decontamination reduced mortality or duration of mechanical ventilation or stay in the intensive care unit.

蓝鱼o_0

蓝鱼o_0 发表于 2011-11-20 22:38

                               
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Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic revie ...

下面是BMJ杂志主效应图。

蓝鱼o_0

可以看出结果非常漂亮。呵呵。

希望这个结论或者干预措施，能够在国内能够验证。

蓝鱼o_0

柳叶刀的这篇文章，我也已经在下载。当下好了就会上传。
请大家到“SIFIC英文文库中去下载”

张淑敏

蓝鱼老师:你好!看来你的英文水平是蛮高的,敬佩,我要向我科的研究生向你学习,我是晚也.

fallwin

蓝鱼斑斑，我觉得“但是碘伏的效应却并不明显”这句，可能翻译为“但是碘伏的效应却并不明确”更为妥当。您后面的评论也点明了，不是没有效果，而是因为样本量太少而未得到有统计学的支持。

拙见，不知对否，还请赐教

感染戈壁

惭愧，我看不懂，有翻译过来的吗？

xiaohutuxian

蓝鱼o_0 发表于 2011-11-20 22:44

                               
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可以看出结果非常漂亮。呵呵。

希望这个结论或者干预措施，能够在国内能够验证。

老师，我刚好做了一个我们医院的院级课题，就是对ICU患者的鼻拭子进行主动监测后然后用碘伏进行去污染，到时候看看最终的效果如何啊，回头一起分享啊，感谢你的翻译，可否介绍下学英语的经验？

safihu

xiaohutuxian 发表于 2011-12-19 16:32

                               
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老师，我刚好做了一个我们医院的院级课题，就是对ICU患者的鼻拭子进行主动监测后然后用碘伏进行去污染，到 ...

为什么考虑用碘伏去污染而不是洗必泰呢？

xiaohutuxian

safihu 发表于 2012-5-15 23:43

                               
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为什么考虑用碘伏去污染而不是洗必泰呢？

洗必泰比较贵。我们科室一老师说用碘伏也可以。我就想试试。

YYGRGLK

太好了，正收集这方面的资料，谢谢！

蓝鱼o_0

Prevention of ventilator-associated pneumonia with oral antiseptics a systematic review and meta-analysis

老文章了，近期又想看看。发现坛子里面没有，我又下了一遍。刚好与我之前发的BMJ的对比一下。

Jenny_song

学习了，希望不久的将来能在科室推广使用。

yuanrobertta

学习一下meta分析的基本写法。

lemon522451631

下载学习了，谢谢老师分享

Dominic

谢谢，下载下来学习一下

阿丹丹

下载学习了，谢谢老师分享