论文部分内容阅读
目的:系统评价我国重症急性胰腺炎（SAP）患者继发胰腺感染的危险因素，为制定感染预防控制策略提供依据。方法:2019年9月，计算机检索PubMed、EMbase、The Cochrane Library、中国生物医学文献数据库（SinoMed）、中国期刊全文数据库（CNKI）、万方数据库（WanFang Data）和维普中文科技期刊全文数据库（VIP），收集关于我国SAP患者继发胰腺感染危险因素的病例对照研究，检索时限均为建库至2019年9月。由2名研究者独立筛选文献、提取资料及评价纳入研究的风险偏倚后，采用Rev Man 5.3软件进行Meta分析。结果:共纳入28项病例对照研究，合计4 584例患者。Meta分析结果显示：病因［n OR=1.18，95%n CI（1.01~1.39）］、糖尿病［n OR=1.78，95%n CI（1.21~2.61）］、低氧血症［n OR=3.01，95%n CI（2.28~3.98）］、机械通气［n OR=2.25，95%n CI（1.86~2.71）］、抗菌药物使用［n OR=0.38，95%n CI（0.27~0.53）］、手术治疗［n OR=2.49，95%n CI（1.77~3.50）］、血红蛋白［n OR=-4.59，95%n CI（-8.47~0.72）］、血钙［n OR=-0.27，95%n CI（-0.42~0.13）］、丙氨酸氨基转移酶（ALT）［n OR=8.12，95%n CI（3.33~12.92）］、Ranson评分［n OR=1.13，95%n CI（0.55~1.72）］、急性生理与慢性健康Ⅱ评分（APACHE Ⅱ评分）［n OR=3.19，95%n CI（2.38~4.00）］、器官功能衰竭个数［n OR=1.47，95%n CI（1.19~1.75）］、禁食时间［n OR=4.69，95%n CI（3.78~5.60）］、胃肠功能障碍时间［n OR=1.90，95%n CI（1.04~2.76）］、肠外营养时间［n OR=6.15，95%n CI（4.00~8.29）］ 是SAP继发胰腺感染的危险因素（均n P<0.05）。n 结论:SAP患者继发胰腺感染与多种因素相关，需要采取针对性的预防措施控制感染。“,”Objective:To systematically evaluate the risk factors of pancreatic infection secondary to severe acute pancreatitis in China,and to provide evidence for the development of infection prevention and control strategies.Methods:A computer-based online search of PubMed, EMbase, The Cochrane Library, SinoMed, CNKI, Wanfang and VIP databases was performed to retrieve the publications regarding case-control studies on the risk factors of pancreatic infection secondary to severe acute pancreatitis published from inception to September 2019. Two researchers independently screened the literature, extracted data and evaluated the risk bias of the included studies. Then, Rev Man 5.3 software was used for meta-analysis.Results:Twenty-eight case-control studies involving 4 584 patients were included for final analysis. Meta-analysis results revealed that etiology [n OR = 1.18, 95%n CI (1.01-1.39)], diabetes [n OR = 1.78, 95%n CI (1.21-2.61)], hypoxemia [n OR = 3.01, 95%n CI (2.28-3.98)], mechanical ventilation [n OR = 2.25, 95%n CI (1.86-2.71)], use of antibiotics [n OR = 0.38, 95%n CI (0.27-0.53)], surgical treatment [n OR = 2.49, 95%CI (1.77-3.50)], hemoglobin [n OR = -4.59], 95%n CI (-8.47-0.72), blood calcium [n OR = -0.27, 95%n CI (-0.42-0.13)], alanine aminotransferase [n OR = 8.12, 95%n CI (3.33-12.92)], Ranson score [n OR = 1.13, 95%n CI (0.55-1.72)], Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scoring system score [n OR = 3.19, 95%n CI (2.38-4.00)], organ failure [n OR = 1.47, 95%n CI (1.19-1.75)], fasting time [n OR = 4.69, 95%n CI (3.78-5.60)], gastrointestinal dysfunction time [n OR = 1.90,95%n CI (1.04-2.76)], parenteral nutrition time [n OR = 6.15, 95%n CI (4.00-8.29)] are the risk factors of pancreatic infection secondary to severe acute pancreatitis (all n P < 0.05).n Conclusion:Pancreatic infection secondary to severe acute pancreatitis is related to a variety of factors, and it is necessary to take targeted preventive measures to control the infection.