侵袭性牙科手术的周围手术抗菌预防:随机和安慰剂控制研究的系统审查和随机效应元分析
Alberto A Iturbe Cordero1, Arturo P Jaramillo2, Jhanmarie Vasquez3
1General Dentistry, Universidad Central de Venezuela, Caracas, VEN.
Cureus
|February 5, 2026
概括
牙科手术前的常规预防性抗微生物药物在减少感染或细菌血症方面并不总是显示出好处. 这种做法可能会破坏口腔微生物群并促进抗菌素耐药性,因此需要仔细考虑患者的风险.
科学领域:
- 口腔微生物组研究
- 传染病流行病学 传染病流行病学
- 牙科外科手术的结果
背景情况:
- 预防性抗微生物药物在侵入性牙科手术前是常见的,以预防感染和细菌病.
- 然而,他们的临床益处是有争议的,人们担心生态破坏和抗菌素耐药性.
- 即使是单剂量也可以改变口腔微生物组,并选择耐药菌株.
研究的目的:
- 在侵入性牙科手术中对预防性抗微生物药物的随机对照试验进行系统的审查和元分析.
- 评估术后预防在减少早期感染并发症和细菌病的有效性.
- 评估二次结果,如术后发病率和对口腔菌群的影响.
主要方法:
- 在PRISMA指导下对PubMed,Embase和Cochrane数据库进行系统审查.
- 包括10个随机的安慰剂受控试验,涉及约1,950名参与者.
- 分析使用了反变率随机效应模型来汇集结果.
主要成果:
- 在所有手术中,预防措施并没有显著降低早期传染性结果/细菌病的主要终点 (MD -0.12,95%CI -0.31至0.07).
- 牙科手术的子组分析也显示没有显著的益处 (MD -0.17,95%CI -0.45至0.11).
- 一些试验表明,使用特定药物 (赫西丁,阿莫西西林-克拉夫兰酸盐) 可以减少细菌病,但抗生素没有改善糖尿病患者的结果,并且增加了止痛药的使用.
结论:
- 在侵袭性牙科手术中,常规的预防性抗菌药物策略对早期感染/细菌病的结果缺乏一致的整体益处.
- 在二次术后发病率上没有明显的改善.
- 微生物学证据表明,通过生态干扰和耐药性选择可能造成危害;未来的试验需要标准化的终点和风险分层.
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