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目的探讨预防性使用抗生素治疗重症急性胰腺炎是否有益。方法在MEDLINE、CNKI、WILLEY数据库上检索1990年1月~2013年5月发表的所有预防性使用抗生素治疗急性重症胰腺炎的相关文献,使用RevMand5.0软件进行分析。结果最终有12个随机对照试验共718例患者纳入Meta分析,其中预防性抗生素组356例,对照组362例。预防性使用抗生素治疗急性坏死性胰腺炎与对照组相比,并不能显著改善生存率(RR 0.78,95%CI 0.53~1.15,P=0.20),也不能降低胰腺感染(RR 0.77,95%CI 0.58~1.02,P=0.07)、胰外感染(RR 0.72,95%CI 0.49~1.06,P=0.09)及手术干预(RR 0.90,95%CI 0.67~1.19,P=0.45)等并发症的发生几率。结论预防性使用抗生素不能降低急性重症胰腺炎患者的死亡率,对SAP患者无明显保护作用。
Objective To investigate the prophylactic use of antibiotics for the treatment of severe acute pancreatitis. Methods The MEDLINE, CNKI and WILLEY databases were used to search the literature about all prophylactic antibiotics used in the treatment of acute severe pancreatitis from January 1990 to May 2013, and analyzed by RevMand5.0 software. Results A total of 718 randomized controlled trials involving 718 patients were included in the meta-analysis, with 356 in the prophylactic antibiotic group and 362 in the control group. Prophylactic antibiotic treatment of acute necrotizing pancreatitis did not significantly improve survival (RR 0.78, 95% CI 0.53 to 1.15, P = 0.20) nor pancreatic infection (RR 0.77, 95% CI 0.58 ~ 1.02, P = 0.07), complications of external pancreatic infection (RR 0.72, 95% CI 0.49-1.06, P = 0.09) and surgical intervention (RR 0.90, 95% CI 0.67-1.19, P = 0.45) probability. Conclusion The prophylactic use of antibiotics can not reduce the mortality of patients with acute severe pancreatitis, no significant protective effect on SAP patients.