本文選題：Er:YAG激光 + 機械窩洞預(yù)備��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:隨著口腔生物材料和微創(chuàng)技術(shù)的發(fā)展,Er:YAG激光逐漸替代傳統(tǒng)機械方法在兒童窩洞預(yù)備中已得到越來越廣泛的應(yīng)用。國內(nèi)外學(xué)者對其臨床療效進(jìn)行了大量的研究,但至今仍缺乏全面的系統(tǒng)性評價。本研究采用循證醫(yī)學(xué)的方法對國內(nèi)外公開發(fā)表的關(guān)于Er:YAG激光在兒童窩洞預(yù)備中應(yīng)用的臨床研究文獻(xiàn)進(jìn)行Meta分析,全面而系統(tǒng)地評價Er:YAG激光在兒童窩洞預(yù)備中應(yīng)用的臨床效果,為其臨床應(yīng)用提供科學(xué)依據(jù)和指導(dǎo)。方法:1檢索文獻(xiàn)途徑和方法計算機與手工檢索相結(jié)合,檢索數(shù)據(jù)庫包括:CNKI(中國期刊網(wǎng)全文數(shù)據(jù)庫),CBM(中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫),VIP(中文科技期刊數(shù)據(jù)庫),萬方數(shù)據(jù)庫,Pubmed,Cochrane圖書館,OVID外文全文數(shù)據(jù)庫,Science Direct全文數(shù)據(jù)庫,檢索國內(nèi)外關(guān)于Er:YAG激光在兒童窩洞預(yù)備中應(yīng)用的臨床療效研究的文獻(xiàn),并對納入研究的文獻(xiàn)進(jìn)行篩選,剔除不符合納入標(biāo)準(zhǔn)及灰色的文獻(xiàn),檢索各數(shù)據(jù)庫從1997年(1997年FDA批準(zhǔn)Er:YAG激光作為牙體硬組織激光應(yīng)用于臨床)到2016年12月的相關(guān)文獻(xiàn)。2文獻(xiàn)納入標(biāo)準(zhǔn)2.1研究設(shè)計本次研究納入文獻(xiàn)均為同期比較Er:YAG激光和傳統(tǒng)機械方法在兒童窩洞預(yù)備中應(yīng)用的臨床隨機對照試驗研究。2.2研究對象:本次研究納入文獻(xiàn)的研究對象均為兒童齲病患者,年齡3-15歲。2.3干預(yù)措施:所有納入文獻(xiàn)的實驗組均采用Er:YAG激光進(jìn)行窩洞預(yù)備。2.4對照措施:所有納入文獻(xiàn)的對照組均采用傳統(tǒng)機械方法進(jìn)行窩洞預(yù)備。修復(fù)體邊緣著色率,修復(fù)體邊緣密合度和繼發(fā)齲率。2.6失訪率20%,能提供有效的數(shù)據(jù)用于計算SMD值、RR值和95%CI。由2位研究者獨立進(jìn)行篩選,包括閱讀文獻(xiàn)題目、摘要及全文。如果遇到不同意見,則兩者討論解決或由權(quán)威專家協(xié)助判斷,最終確定納入的文獻(xiàn)。3對納入研究的文獻(xiàn)進(jìn)行質(zhì)量評價和提取資料由2位研究者獨立對文獻(xiàn)進(jìn)行質(zhì)量評價和提取資料。采用2002年Banares提出的改良后的Jadad量表對本研究的納入文獻(xiàn)進(jìn)行質(zhì)量評價。計分標(biāo)準(zhǔn)為1~7分,其中1~3分視為低質(zhì)量文獻(xiàn),4~7分視為高質(zhì)量文獻(xiàn),同期按照本研究方案提取納入文獻(xiàn)的基本特征和有效數(shù)據(jù)。4統(tǒng)計分析采用stata11.0軟件對納入文獻(xiàn)進(jìn)行統(tǒng)計分析。因本研究納入文獻(xiàn)中操作時間和疼痛評價屬于計量資料,故選擇標(biāo)準(zhǔn)化均數(shù)差(standardized mean difference,SMD)和95%可信區(qū)間(confidence interval,CI)表示效應(yīng)量;其修復(fù)體完全保留率,修復(fù)體邊緣著色率,修復(fù)體邊緣密合度和繼發(fā)齲率為分類資料,故計算相對危險度(relative risk,RR)和95%可信區(qū)間(confidence interval,CI)作為其效應(yīng)量。首先對納入研究的文獻(xiàn)進(jìn)行Q檢驗,根據(jù)異質(zhì)性檢驗結(jié)果:若多個研究間具有同質(zhì)性即P0.1,選擇固定效應(yīng)模型進(jìn)行分析;若多個研究間不具有同質(zhì)性即P0.1,選擇隨機效應(yīng)模型進(jìn)行分析,通過Begg秩相關(guān)方法檢驗納入文獻(xiàn)是否存在發(fā)表偏倚。結(jié)果:1檢索結(jié)果:從所選數(shù)據(jù)庫中檢索出相關(guān)文獻(xiàn)共計768篇,最后符合納入標(biāo)準(zhǔn)的文獻(xiàn)有7篇(中文4篇,英文3篇)。2納入文獻(xiàn)質(zhì)量評價結(jié)果:依據(jù)修正后的Jadad量表對納入文獻(xiàn)進(jìn)行質(zhì)量評價,其結(jié)果顯示:3篇為低質(zhì)量文獻(xiàn),4篇為高質(zhì)量文獻(xiàn)。3 Meta分析結(jié)果3.1 Er:YAG激光與傳統(tǒng)機械方法比較:Er:YAG激光在窩洞預(yù)備時操作時間更長(SMD=1.945,95%CI=0.942-2.948,P0.001,合并效應(yīng)量的檢驗Z=3.80,P0.001);2.5療效判斷標(biāo)準(zhǔn)主要包括:操作時間,疼痛評價,修復(fù)體完全保留率,程中產(chǎn)生的疼痛更輕微,兩者差異具有統(tǒng)計學(xué)意義(SMD=-1.013,95%CI=-1.829--0.196,P0.001,合并效應(yīng)量的檢驗Z=2.43,P=0.015);3.3 Er:YAG激光和傳統(tǒng)機械方法窩洞預(yù)備完成,同種材料充填治療后比較:兩者在修復(fù)體完全保留率方面差異無統(tǒng)計學(xué)意義(三個月復(fù)查:RR=1.015,95%CI=0.925-1.113,P=0.773,合并效應(yīng)兩檢驗Z=0.31,P=0.754;六個月復(fù)查:RR=1.011,95%CI=0.937-1.091,P=0.495,合并效應(yīng)量的檢驗Z=0.28,P=0.783;一年復(fù)查:RR=1.021,95%CI=0.936-1.114,P=0.190,合并效應(yīng)量的檢驗Z=0.47,P=0.636);3.4 Er:YAG激光和傳統(tǒng)機械方法窩洞預(yù)備完成,同種材料充填治療后比較:兩者在修復(fù)體邊緣著色方面差異無統(tǒng)計學(xué)意義(三個月復(fù)查:RR=0.337,95%CI=0.036-3.169,P=0.992,合并效應(yīng)量的檢驗:Z=0.95,P=0.342;六個月復(fù)查:RR=1.298,95%CI=0.300-5.615,P=0.892,合并效應(yīng)量的檢驗:Z=0.35,P=0.727;一年復(fù)查:RR=1.638,95%CI=0.224-11.986,P=0.594,合并效應(yīng)量的檢驗:Z=0.49,P=0.627);3.5 Er:YAG激光和傳統(tǒng)機械方法窩洞預(yù)備完成,同種材料充填治療后比較:兩者在修復(fù)體邊緣密合度方面差異無統(tǒng)計學(xué)意義(六個月復(fù)查:RR=0.969,95%CI=0.063-14.799,P0.001,合并效應(yīng)量的檢驗:Z=0.02,P=0.981;一年復(fù)查:RR=1.480,95%CI=0.257-8.515,P=0.692,合并效應(yīng)量的檢驗:Z=0.44,P=0.661)。3.6繼發(fā)齲率:stata11.0軟件提示:數(shù)據(jù)不充分,無法繼續(xù)完成該Meta分析,對該指標(biāo)進(jìn)行定量分析,其中Rodrigo A V的研究中修復(fù)后觀察一年Er:YAG激光組繼發(fā)齲率為0%,傳統(tǒng)機械組繼發(fā)齲率也為0%,SPSS統(tǒng)計結(jié)果顯示兩者差異無統(tǒng)計學(xué)意義;Galia G的研究中,修復(fù)后觀察一年得出的結(jié)論與Rodrigo A V的結(jié)果具有一致性。結(jié)論:1關(guān)于Er:YAG激光在兒童窩洞預(yù)備中應(yīng)用的臨床隨機對照試驗研究總體質(zhì)量偏低,尤其關(guān)于樣本量,隨機化隱藏和盲法等方面需要更加完善,且符合納入標(biāo)準(zhǔn)的文獻(xiàn)數(shù)量較少。這一結(jié)論提示在未來的應(yīng)用與研究中需要增加高質(zhì)量的臨床隨機對照試驗。2敏感性分析結(jié)果表明:Meta分析的結(jié)果穩(wěn)定,可靠,能真實準(zhǔn)確反映Er:YAG激光在兒童窩洞預(yù)備中應(yīng)用的臨床療效。3.2 Er:YAG激光與傳統(tǒng)機械方法比較:Er:YAG激光在窩洞預(yù)備時操作過3本次研究的Meta分析結(jié)果顯示:1)與傳統(tǒng)機械方法相比,Er:YAG激光用于兒童窩洞預(yù)備時,兩者在修復(fù)體完全保留率,修復(fù)體邊緣著色和修復(fù)體邊緣密合度方面差異無統(tǒng)計學(xué)意義。2)在操作過程中產(chǎn)生疼痛感方面Er:YAG激光明顯優(yōu)于傳統(tǒng)機械方法。3)與傳統(tǒng)機械方法相比,Er:YAG激光操作時間更長。4 Er:YAG激光應(yīng)用于兒童窩洞預(yù)備的臨床效果良好,安全、可靠,患兒產(chǎn)生痛覺少,值得臨床推廣。
[Abstract]:Objective: with the development of oral biomaterials and minimally invasive techniques, the Er:YAG laser has been gradually replaced by the traditional mechanical method in the preparation of children's nest. The domestic and foreign scholars have done a lot of research on its clinical efficacy, but still lack comprehensive systematic evaluation. This study adopts the method of evidence-based medicine to the country. A Meta analysis of the clinical literature on the application of Er:YAG laser in the preparation of pit holes in children was published in and out of China. The clinical effects of Er:YAG laser in the preparation of pit holes in children were evaluated comprehensively and systematically, and the scientific basis and guidance for its clinical application were provided. Method: 1 retrieval of documents and methods by computer and manual retrieval The retrieval database includes: CNKI (Chinese Journal Network full text database), CBM (Chinese biomedical literature database), VIP (Chinese sci-tech journal database), Wanfang database, Pubmed, Cochrane library, OVID full text database and Science Direct full text database, to retrieve the application of Er:YAG laser in the children's nest preparation. The literature of the clinical efficacy study was selected and the literature included in the study was screened to eliminate the documents that did not conform to the inclusion criteria and gray, and to retrieve each database from 1997 (1997 FDA approved Er:YAG laser as the dental hard tissue laser applied to the clinic) to December 2016 related documents into the standard 2.1 research design. A randomized controlled trial of Er:YAG laser and traditional mechanical methods used in the preparation of pit holes for children in the same period was studied in the.2.2 study. The subjects included in this study were children's caries and age 3-15 years old.2.3 intervention measures: all the experimental groups included Er:YAG laser for cavities. .2.4 control measures: all the control groups that were included in the literature were prepared by traditional mechanical methods. The edge coloring rate of the prosthesis, the edge density of the prosthesis and the secondary caries rate of.2.6 were 20%, and the effective data could be used to calculate the SMD value. The RR value and 95%CI. were screened by 2 researchers independently, including reading literature titles, Abstract and full text. If different opinions are met, the two discussions are solved or by authoritative experts, and finally the quality evaluation and extraction of the included literature.3 on the documents included in the study are evaluated and extracted by the 2 researchers independently of the literature. The modified Jadad scale proposed by Banares in 2002 is used. The study included the quality evaluation of the literature. The score standard was 1~7. The 1~3 scores were considered as low quality literature, 4~7 was considered as the high quality literature. The basic features and effective data of the literature were extracted according to this research scheme in the same period, and the statistical analysis of the effective data was analyzed by stata11.0 software. The research was included in the literature. The operation time and pain evaluation belonged to the measurement data, so the standardized mean difference (SMD) and the 95% confidence interval (confidence interval, CI) were selected to express the effect. The total retention rate of the prosthesis, the edge coloring rate of the prosthesis, the edge density of the prosthesis and the secondary caries rate were classified, so the relative risk degree (R) was calculated. Elative risk, RR) and the 95% confidence interval (confidence interval, CI) as their effects. First, we conduct Q tests on the literature included in the study, according to the heterogeneity test results: if multiple studies have homogeneity, namely P0.1, select the fixed effect model; if multiple studies do not have homogeneity, i.e. P0.1, choose random effect model into the model. The Begg rank correlation method was used to test whether there was a publication bias in the literature. Results: 1 retrieval results: 768 articles were retrieved from the selected database, and 7 articles (4 in Chinese and 3 in English) were included in the literature of the selected database, and the results were included in the quality evaluation of the literature: the revised Jadad scale was used for the inclusion of the literature. The results showed that 3 articles were low quality literature, 4 were high quality literature.3 Meta analysis, 3.1 Er:YAG laser was compared with traditional mechanical method: Er:YAG laser had longer operation time in pit preparation (SMD=1.945,95%CI=0.942-2.948, P0.001, Z=3.80, P0.001), and 2.5 evaluation criteria included: Operation time, pain evaluation, complete retention rate of the prosthesis, the pain produced in the process was more mild, and the difference was statistically significant (SMD=-1.013,95%CI=-1.829--0.196, P0.001, Z=2.43, P=0.015); 3.3 Er:YAG laser and traditional mechanical method of cavity preparation were completed, and the same material filling treatment was compared: both were repaired. There was no significant difference in total body retention rate (three months reexamination: RR=1.015,95%CI=0.925-1.113, P=0.773, combined effect two test Z=0.31, P=0.754; six months reexamination: RR=1.011,95%CI=0.937-1.091, P=0.495, Z=0.28, P=0.783; one year review: RR=1.021,95%CI=0.936-1.114, P=0.190, combined effect test Z. =0.47, P=0.636); 3.4 Er:YAG laser and traditional mechanical method of cavity preparation completed, the same material filling treatment compared: the two in the restoration of marginal color difference is not statistically significant (three months reexamination: RR=0.337,95%CI=0.036-3.169, P=0.992, combined effect test: Z=0.95, P=0.342; six months reexamination: RR=1.298,95%CI=0.300-5.615: RR=1.298,95%CI=0.300-5.615 P=0.892, test of combined effect: Z=0.35, P=0.727; one year review: RR=1.638,95%CI=0.224-11.986, P=0.594, test of combined effect: Z=0.49, P=0.627); 3.5 Er:YAG laser and traditional mechanical method of cavity preparation completed, and the same material filling treatment compared: there was no statistical difference between the two on the edge density of the restorations (six Monthly review: RR=0.969,95%CI=0.063-14.799, P0.001, combined effect test: Z=0.02, P=0.981; one year review: RR=1.480,95%CI=0.257-8.515, P=0.692, combined effect test: Z=0.44, P=0.661).3.6 secondary caries rate: stata11.0 software: data is not sufficient to continue the Meta analysis, quantitative analysis of the index, including Ro In the study of drigo A V, the secondary caries rate of the one year Er:YAG laser group was 0%, and the secondary caries in the traditional mechanical group was 0%, and the SPSS statistical results showed that there was no statistical difference between them. In the study of Galia G, the conclusion was consistent with the result of Rodrigo A V. Conclusion: 1 about Er:YAG laser in children's nest. The total quality of the clinical randomized controlled trial used in the preparation of the cavities is low, especially on the sample size, randomization and blindness, and the number of documents which conform to the standard is less. This conclusion suggests that high quality clinical randomized controlled trial.2 sensitivity scores need to be increased in future applications and studies. The results show that the results of Meta analysis are stable, reliable, and can truly reflect the clinical effect of Er:YAG laser in the preparation of children's pit and cave..3.2 Er:YAG laser is compared with traditional mechanical method. The results of Meta analysis operating 3 times when Er:YAG laser has been prepared in the hole preparation show: 1) compared with the traditional mechanical method, the Er:YAG laser is used. There is no significant difference in the total retention rate of the prosthesis, the edge coloration of the prosthesis and the edge cohesion of the prosthesis,.2). In the operation process, the Er:YAG laser is obviously superior to the traditional mechanical method.3) compared with the traditional mechanical method, and the Er:YAG laser operation time is longer than the.4 Er:YAG laser. It has good clinical effect, safe and reliable for children's cavity preparation. It has less pain and is worthy of clinical promotion.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R788.1

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