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[摘要]
目的 系统评价新生儿发生抗生素相关性腹泻(AAD)的危险因素,为临床提供循证医学证据。方法 检索PubMed、Embase、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)和万方数据库等相关数据库,收集新生儿发生AAD危险因素的病例对照研究,检索时限为2000年1月-2018年5月,应用Rev Man 5.2软件进行Meta-分析。结果 共纳入13篇文献,涉及4 273例新生儿,其中AAD组915例,非AAD组3 358例。Meta-分析结果显示:低胎龄(SMD=-0.89,95%CI=-1.16~-0.61,P<0.01),出生时体质量偏小(SMD=-0.79,95%CI=-0.98~-0.59,P<0.01),日龄偏小(SMD=-1.08,95%CI=-1.20~-0.96,P<0.01),抗生素种类(SMD=1.59,95%CI=1.24~1.94,P<0.01),侵袭性操作(OR=2.06,95%CI=1.85~2.23,P<0.01),住院天数(SMD=2.21,95%CI=1.86~2.56,P<0.01)和非纯母乳喂养(OR=0.47,95%CI=0.38~9.57,P<0.01)是新生儿发生AAD的危险因素,抗生素预防用药(OR=1.17,95%CI=0.94~1.46,P>0.05)与新生儿发生AAD无关。结论 低胎龄、出生时体质量偏小、日龄小、多种抗生素联合用药、住院时间过长、侵袭性操作和非纯母乳喂养是新生儿发生AAD的危险因素。
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[Abstract]
Objective To evaluate the risk factors for antibiotic-associated diarrhea (AAD) in neonates,and to provide evidencebased medical for clinical.Method The related databases of PubMed,Embase,CNKI,CBM,VIP and Wanfang Data were electronically searched for the case-control studies about risk factors for AAD in neonates from January 2010 to May 2018.Metaanalysis was conducted by RevMan 5.2 Software.Results A total of 13 studies involving 4 273 patients were studied,including 915 in the AAD group and 3 358 in the non-AAD group.The result of Meta-analysis showed that,the lower gestational age (SMD=-0.89,95%CI=-1.16~-0.61,P<0.01),lower birth weight (SMD=-0.79,95%CI=-0.98~-0.59,P<0.01),lower days age (SMD=-1.08,95%CI=-1.20~-0.96,P<0.01),combination of antibiotic (SMD=1.59,95%CI=1.24~1.94,P<0.01),longer hospital stay (SMD=2.21,95%CI=1.86~2.56,P<0.01),Invasive procedures (OR=2.06,95%CI=1.85~2.23,P<0.01) and non-pure breastfeeding (OR=0.47,95%CI=0.38~9.57,P<0.01) were risk factors for AAD in neonates,and prevention of antibiotic (OR=1.17,95%CI=0.94~1.46,P>0.05) was no risk factor for AAD in neonates.Conclusion Lower gestational age,lower birth weight,lower age,combination of antibiotics,longer hospital stay,Invasive procedures and non-pure breastfeeding are risk factors for AAD in neonates.
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