【摘要】：目的：評估糖皮質激素對建立人工氣道后咽喉部并發(fā)癥預防作用的有效性及安全性。 方法：計算機檢索了英文數(shù)據(jù)庫：EMBASE、PubMed、ISI Web of Knowledge、The CochraneLibrary；中文數(shù)據(jù)庫：中國生物醫(yī)學數(shù)據(jù)庫、萬方數(shù)據(jù)庫、維普數(shù)據(jù)庫、中國知網(wǎng)數(shù)據(jù)庫，同時手工檢索了相關研究的參考文獻。查找局部或全身使用激素與安慰劑或空白對照組相比，預防建立人工氣道后咽喉部并發(fā)癥的隨機對照試驗。本研究的建立人工氣道后咽喉部并發(fā)癥包括咽喉痛、聲嘶、咳嗽。由兩個研究者根據(jù)納入和排除標準獨立篩選文獻，評估研究質量及偏倚風險情況，并應用RevMan5.2軟件進行Meta分析。 結果：共納入19個隨機對照試驗，共有2084例個病例，其中激素組1241例，對照組843例。激素可降低術后咽喉痛、聲嘶、咳嗽的發(fā)病率，術后1-3小時（hour，h）的相對危險度（relativerisk，，RR）值及95%的置信區(qū)間（confidence interval，CI）分別為0.50[0.37,0.67]、0.43[0.30,0.61]、0.55[0.35,0.88]，需要防治的病例數(shù)（number needed to treat，NNT）分別為4.0、3.9、7.9；術后24h的RR值及95%CI分別為0.51[0.43,0.60]、0.58[0.48,0.70]、0.42[0.22,0.82]，NNT分別為5.5、5.6、5.6。同時糖皮質激素也降低術后咽喉痛的程度，1-3h、24h的標準化均數(shù)差分別為-1.47[-1.85,-1.09]、-0.97[-1.40,-0.53]，在糖皮質激素的不良反應上，僅2個研究有描述，且未發(fā)現(xiàn)糖皮質激素相關不良反應，其余均未報告。 結論：使用糖皮質激素可降低成人建立人工氣道后咽喉部并發(fā)癥的發(fā)病率，且用藥途徑可對糖皮質激素的預防效果產生影響，局部用藥效果優(yōu)于全身用藥。
[Abstract]:Objective: to evaluate the efficacy and safety of glucocorticoid in the prevention of pharynx and larynx complications after the establishment of artificial airway. Methods: the English database: EMBASEE PubMedi Web of knowledge of the Cochrane Library was searched by computer; the Chinese database: China Biomedical Database, Wanfang Database, Weip Database, China knowledge Network Database, and the related references were searched by hand. A randomized controlled trial was conducted to find out whether local or systemic use of hormones was compared with placebo or blank control to prevent complications of the pharyngopharynx after the establishment of artificial airways. Complications following the establishment of an artificial airway in this study included sore throat, hoarseness, and cough. According to the inclusion and exclusion criteria, two researchers independently sifted the literature to evaluate the quality of the study and bias risk, and used Revman 5.2 software to conduct meta-analysis. Results: a total of 2084 cases were included in 19 randomized controlled trials, including 1241 cases in hormone group and 843 cases in control group. Hormone could reduce the incidence of larynx, hoarseness and cough. The relative risk (RR) and 95% confidence interval (CI) of 1-3 hours after operation were 0.50 [0.370.67] 0.43 [0.300.61] 0.55 [0.350.88], and the number of cases in need of prevention and treatment were 4.03.97.9nt; The RR value and 95 CI at 24 hours after operation were 0.51 [0.43 鹵0.60] 0.58 [0.488 0.70] 0.42 [0.22 ~ 0.82] respectively. At the same time, glucocorticoid also reduced the degree of larynx pain after operation. The standardized mean difference of 24 hours after operation was -1.47 [-1.85 ~ 1.09] -0.97 [-1.40 ~ 0.53]. Only two studies described the adverse effects of glucocorticoid, and no glucocorticoid-related adverse reactions were found, and no other adverse reactions were reported. Conclusion: the use of glucocorticoid can reduce the incidence of pharynx and larynx complications after the establishment of artificial airway in adults, and the preventive effect of glucocorticoid can be affected by the way of medication, and the effect of local administration is better than that of the whole body.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614

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