儿童化脓性脑膜炎药物治疗循证指南的系统评价
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篇名: 儿童化脓性脑膜炎药物治疗循证指南的系统评价
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摘要: 目的:系统评价儿童化脓性脑膜炎药物治疗的相关循证指南,为临床治疗提供循证参考。方法:计算机检索 PubMed、EMBase、中国生物医学文献数据库、万方数据库、中文科技期刊数据库、中国期刊全文数据库、美国国立指南数据库(NGC)、国际指南数据库(GIN)、TRIP指南数据库以及国内外各大医学会和行业机构网站,纳入儿童化脓性脑膜炎治疗的循证指南,提取资料并评价质量后,再进行循证评价。结果:最终纳入3篇指南,制定时间为2004-2012年,分别来自美国、英国、澳大利亚。3篇指南最终推荐均为B级,在指南研究与评价的评审工具(AGREE)Ⅱ涉及的各领域中“范围与目的”和“清晰性”的总体得分最高,均超过70%,而得分普遍较低的是“应用性”。化脓性脑膜炎新生儿推荐采用青霉素类联合头孢噻肟,而对于婴幼儿和儿童则推荐头孢噻肟或头孢曲松(疑有肺炎链球菌感染时联合万古霉素)。治疗剂量和疗程各指南有一定差异,新生儿疗程通常应更长。各指南对糖皮质激素的使用均持赞成态度。结论:儿童化脓性脑膜炎药物的选择,各指南推荐内容基本一致,无地区差异,但剂量和疗程有一定差异。各指南对证据级别和推荐强度的划分标准不一,有待进一步完善,同时各指南在制定的严谨性和应用性上要进一步加强。
ABSTRACT: OBJECTIVE: To systematically review the related evidence-based guidelines of purulent meningitis in children, and to provide evidence-based reference for clinical treatment. METHODS: Retrieved from PubMed, EMBase, CBM, Wanfang Database, CJFD and VIP, NGC, GIN, TRIP and websites of domestic and international medical associations and industry bodies, the treatment guidelines about purulent meningitis in children were collected. Evidence-based evaluation was performed after data extraction and quality evaluation. RESULTS: Finally 3 guidelines were enrolled in total, with development time ranging from 2004 to 2012, from USA, Britain and Australia, respectively. All of the recommendations were level B, "scope and purpose" and "clarity" showed the higher scores in AGREEⅡ, more than 70%, and "applicability" showed generally low scores. Penicillin and cefotaxime were recommended in purulent meningitis of neonates, and vancomycin combined with cefotaxime or ceftriaxone were recommended for infants and children(it was combined with vancomycin when Streptococcus pneumoniae infection was suspected). The dose and duration of each guideline were certain different, and the period of treatment should be longer in neonates. In addition, the glucocorticoid was recommended in all guidelines. CONCLUSIONS: The recommendations of medicines for the treatment of purulent meningitis are basically unanimous, with no regional difference, but there are some differences about dose and the course of treatment. In addition, the classification criteria of the levels of evidence and recommendation are still suboptimal, which needs further improvement. And guidelines on purulent meningitis should be improved in "rigour" and "applicability" in future.
期刊: 2016年第27卷第21期
作者: 张宏亮,李南,黄振光,廖乙媚,刘滔滔
AUTHORS: ZHANG Hongliang,LI Nan,HUANG Zhenguang,LIAO Yimei,LIU Taotao
关键字: 化脓性脑膜炎;儿童;指南研究与评价的评审工具Ⅱ;系统评价;循证指南
KEYWORDS: Purulent meningitis; Children; AGREEⅡ; Systematic review; Evidence-based medication
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