本文選題：WONCA + 系統(tǒng)綜述�。� 參考：《中國全科醫(yī)學(xué)》2015年15期

【摘要】：目的探討對乙酰氨基酚(撲熱息痛)治療脊椎疼痛和骨關(guān)節(jié)炎(髖關(guān)節(jié)、膝關(guān)節(jié))的有效性和安全性。設(shè)計系統(tǒng)綜述和薈萃分析。數(shù)據(jù)來源Medline、荷蘭醫(yī)學(xué)文摘數(shù)據(jù)庫(EMBase)、AMED、CINAHL、Web of Science、LILACS、國際藥學(xué)文摘、Cochrane對照試驗中心注冊庫,時間自建庫至2014年12月。研究的納入標(biāo)準(zhǔn)研究須為隨機對照試驗,比較撲熱息痛和安慰劑治療脊椎疼痛(頸痛或下腰痛)和骨關(guān)節(jié)炎(髖關(guān)節(jié)、膝關(guān)節(jié))的療效和安全性。數(shù)據(jù)的提取由2名獨立的研究人員分別提取關(guān)于疼痛、失能和生活質(zhì)量的數(shù)據(jù)。次要結(jié)果指標(biāo)包括:不良反應(yīng)、患者依從性和急救藥物的使用。疼痛和失能評分轉(zhuǎn)換為0(沒有疼痛或失能)到100(疼痛加重和失能)的數(shù)值。采用隨機效應(yīng)模型計算加權(quán)均數(shù)差(WMD)或風(fēng)險比(HR)以及95%可信區(qū)間(95%CI)。應(yīng)用Cochrane協(xié)作工具對偏倚風(fēng)險進行評估,采用GRADE方法對證據(jù)的質(zhì)量進行評估,并對結(jié)論進行總結(jié)。結(jié)果共納入12篇報道(13項隨機試驗)。對于下腰痛患者,撲熱息痛在短期內(nèi)減少疼痛強度〔WMD=-0.5,95%CI(-2.9,1.9)〕、失能〔WMD=0.4,95%CI(-1.7,2.5)〕或提高生活質(zhì)量〔WMD=0.4,95%CI(-0.9,1.7)〕等方面均是無效的。對于髖關(guān)節(jié)炎或膝關(guān)節(jié)炎患者,撲熱息痛在短期內(nèi)減輕疼痛〔WMD=-3.7,95%CI(-5.5,1.9)〕、失能〔WMD=-2.9,95%CI(-4.9,0.9)⺗方面有顯著作用,盡管在臨床意義上不重要。報告任何不良反應(yīng)〔HR=1.0,95%CI(0.9,1.1)〕、任何嚴(yán)重不良反應(yīng)〔HR=1.2,95%CI(0.7,2.1)〕或因為不良事件退出研究〔HR=1.2,95%CI(0.9,1.5)〕的患者數(shù)量,在撲熱息痛組和安慰劑組中類似。堅持治療的患者數(shù)量〔HR=1.0,95%CI(0.9,1.1)〕和使用急救藥物〔HR=0.7,95%CI(0.4,1.3)〕的患者數(shù)量,在兩組之間也是相似的。撲熱息痛組患者發(fā)生肝功能異常的概率是安慰劑組患者的4倍〔HR=3.8,95%CI(1.9,7.4)〕,但這種效應(yīng)的臨床意義是不確定的。結(jié)論撲熱息痛在治療腰痛方面是無效的,但可以對骨關(guān)節(jié)炎患者提供最小的短期利益�，F(xiàn)有的臨床實踐指南推薦對下腰痛患者、髖關(guān)節(jié)或膝關(guān)節(jié)骨關(guān)節(jié)炎患者使用撲熱息痛治療,以上研究結(jié)果支持對這些推薦進行重新審議。
[Abstract]:Objective to investigate the efficacy and safety of paracetamol (paracetamol) in the treatment of spinal pain and osteoarthritis. Design system review and meta-analysis. Data source: Medline, Netherlands Medical Abstract Database EMBase CINAHLN Web of Science LILACS.International Pharmaceutical Abstracts Cochrane controlled trial Center Registry, built from December 2014. A randomized controlled trial was required to compare the efficacy and safety of paracetamol and placebo in the treatment of spinal pain (neck pain or low back pain) and osteoarthritis (hip, knee joint). Data were extracted by two independent researchers on pain, disability and quality of life. Secondary outcome measures included adverse reactions, patient compliance, and the use of first aid drugs. The pain and disability score was converted to a value of 0 (no pain or disability) to 100 (pain aggravation and disability). The weighted mean difference (WMD) or risk ratio (HRR) and 95% confidence interval (95% CI) were calculated by the stochastic effect model. The bias risk was evaluated by Cochrane collaboration tool, the quality of evidence was evaluated by Grade method, and the conclusions were summarized. Results A total of 12 reports were included in 13 randomized trials. For patients with low back pain, paracetamol was ineffective in reducing pain intensity in a short period of time, such as reducing pain intensity (WMD-0.9 ~ 1.9), incapacitating WMD-0.45 ~ (95) CI-1.72.5) or improving the quality of life (WMD-0.44 ~ 95CI-0.91.7). For patients with hip arthritis or knee arthritis, paracetamol relieves pain in a short period of time. This aspect has a significant effect, although it is not important in clinical sense. The number of patients who reported any adverse reactions (HR1. 0. 9 / 1.1, HR1. 2 / 95) or withdrawal from the study because of adverse events were similar to those in the paracetamol group and placebo group (P & lt; 0.05). The number of patients who reported any adverse reactions were similar to those in the paracetamol group and the placebo group, and the number of patients who withdrew from the study because of adverse events was similar to that in the paracetamol group and the placebo group. The number of patients who insisted on the treatment was similar between the two groups. The number of patients who were treated with HR1. 0. 9% and 1. 1%) and with the first aid drug HR0. 7 / 95% CI 0. 4 / 1. 3) were also similar between the two groups. The incidence of hepatic dysfunction in paracetamol group was 4 times higher than that in placebo group, but the clinical significance of this effect was uncertain. Conclusion Paracetamol is ineffective in the treatment of low back pain, but it can provide minimal short-term benefits for osteoarthritis patients. Current clinical practice guidelines recommend paracetamol therapy for patients with low back pain, hip or knee osteoarthritis, and these findings support a review of these recommendations.
【分類號】：R684;R681.5

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