MTAD与次氯酸钠临床根管冲洗剂使用效能系统评价与META分析

发布时间：2018-05-13 04:02

本文选题：根管冲洗剂 + MTAD　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:目前对于根管冲洗剂的研究大多拘泥于MTAD与次氯酸钠的各自原始研究上,研究指出两者存在去除玷污层、杀灭细菌以及溶解牙髓这三点共性,基于此本文通过循证医学系统评价的方法来客观判定MTAD能否取代(部分取代)次氯酸钠在临床上的使用,探索MTAD与次氯酸钠在玷污层去除能力以及杀菌能力方面能否替代;对MTAD与次氯酸钠在玷污层去除能力、杀灭粪肠球菌能力、杀菌有效率三者的差异进行统计学假设检验;方法:通过检索Pubmed、Embase、Ovid MEDLINE(R)In-ProcessOther Non-Indexed Citations,Ovid MEDLINE(R)Daily and Ovid MEDLINE(R)(via.ovid)、Cochranelibrary、CNKI、WANFANGDATA、SinoMed等数据库,并手工检索山西医科大学图书馆以及山西医科大学口腔医院牙周科藏书,相关会议文献,以及所有纳入研究的参考文献。严格按照PICOS原则、纳入和排除标准,对所纳入文献进行数据提取以及偏倚风险评估。分别选择SMD、OR作为效应量指标对MTAD与次氯酸钠之间玷污层去除能力以及其杀菌有效率采用revman5.3进行META分析。当50%I275%对其实验设计、实验器械及实验地点进行分析,未能找到者选择随机效应模型,谨慎接受结果;当I275%且异质性无法找出之者,进行描述性系统评价报道各个文献的研究过程及结果,对效应量不进行合并,采用Greadpro3.6.1对结局指标进行评级,使用AMSTAR量表评估方法学。结果:本课题共检出文章220篇,经过初筛剩余文献21篇,复筛之后排除6篇,最终纳入15篇,对照组与试验组总共483例样本,根据各结局指标分组,分别进行META分析及系统评价,META分析结果显示:在玷污层去除能力纳入4项研究,样本共计60例,其合并效应量95%可信区间是:-1.58[-2.35,-0.82],Z检验结果Z=4.07,P0.0001,说明在次氯酸钠组与MTAD组在玷污层去除能力上差异具有统计学意义;杀灭粪肠球菌能力纳入研究3项,样本量在103例,其合并效应量95%CI:0.26[-0.14,0.65],其结果P=0.2,说明研究结果次氯酸钠组与MTAD组在杀灭粪肠球菌能力上差异不具有统计学意义;抑菌环直径纳入研究4项,样本量100例,因异质性为96%故放弃合并统计量的计算,转作描述性评价,针对异质性讨论结果来说,本课题并未将四者做合并,而是分述四者的结果统计:Tay组未通过无效线,95%CI:3.89[2.62,5.17];而李新军组通过无效线,95%CI:-0.43[-1.15,0.30];于鑫未通过无效线,95%CI:16.17[11.10,21.23];Torabinejad,通过无效线,95%CI:0.36[-0.63,1.35];在杀菌有效率OR这一指标中,纳入研究4项,样本量共计220例,其合并效应量Z=4.72、95%CI:14.80[4.84,45.29],说明在次氯酸钠组与MTAD组在杀菌有效率上差异具有统计学意义。结论:通过META分析可以得出:MTAD在玷污层去除能力和杀菌有效率就目前资料来说是优于次氯酸钠,两者在杀灭粪肠球菌能力上不认为有差别;对于两者在抑菌环指标上所展现的性能优劣,就目前所获的资料中尚不能得出一个如是或者否一样有明确意义的清晰结论。
[Abstract]:Objective: at present, most of the studies on root canal flushing agents are based on the original studies of MTAD and sodium hypochlorite. The results show that there are three commonalities in removing smear layer, killing bacteria and dissolving dental pulp. Based on this, this paper objectively determines whether MTAD can replace (partially replaced) sodium hypochlorite in clinical use, and explores whether MTAD and sodium hypochlorite can be substituted in the removal of smear layer and bactericidal ability through the method of Evidence-based medicine system evaluation. The differences of MTAD and sodium hypochlorite removal ability in smear layer, killing ability of Enterococcus faecalis and bactericidal efficiency were tested by statistical hypothesis. The library of Shanxi Medical University and the dental department of Stomatology Hospital of Shanxi Medical University were searched by hand. Data extraction and bias risk assessment are performed according to PICOS principles, inclusion and exclusion criteria. The removal ability of smear layer between MTAD and sodium hypochlorite and its bactericidal efficiency were analyzed by META with revman5.3. When 50% of I275% analyzed the design of the experiment, the instrument and the site of the experiment, the person who failed to find the random effect model and accepted the result cautiously, when I 275% and the heterogeneity could not be found, The research process and results of each literature were evaluated by descriptive systematic evaluation. The effect quantity was not combined. Greadpro3.6.1 was used to grade the outcome index and AMSTAR scale was used to evaluate the methodology. Results: a total of 220 articles were detected, 21 articles were screened, 6 articles were excluded after screening again, and 15 articles were included. 483 samples were collected from the control group and the experimental group, and were grouped according to each outcome index. The results of META analysis and systematic evaluation showed that the removal ability of smear layer was included in 4 studies, and 60 samples were collected. The 95% confidence interval of the combined effect was: 1: -1.58 [-2.35- 0.82] Z test results showed that in sodium hypochlorite group and MTAD group, there was statistical difference in the ability of smear layer removal, the ability of killing Enterococcus faecalis was included in the study, the sample size was 103 cases. The combined effect of 95%CI:0.26 [-0.140.65] and P0. 2 showed that there was no significant difference in the ability of killing Enterococcus faecalis between sodium hypochlorite group and MTAD group, and the diameter of bacteriostasis ring was included in the study, and the sample size was 100 cases. Because the heterogeneity is 96%, we give up the calculation of merging statistics and change it to descriptive evaluation. In view of the discussion of heterogeneity, we do not combine the four. The results of the four are as follows: Tay did not pass the invalid line 95CI: 3.89 [2.62n5.17]; the Li Xinjun group passed the invalid line 95CI-0.43 [-1.150.30]; the Yu Xin failed the invalid line 95CI16.17 [11.1021.23] Torabine jadand passed the invalid line 95CI: 0.36 [-0.631.35]; in the index of germicidal efficiency OR, four items were included in the study, with a total sample size of 220 cases. The combined effect of ZH4. 72C95% CI: 14.80 [4.84 + 45.29], which indicated that the bactericidal efficiency of sodium hypochlorite group and MTAD group was significantly different. Conclusion: through META analysis, we can draw the conclusion that the ability of removing smear layer and bactericidal efficiency of WMTAD is better than that of sodium hypochlorite in the present data, but there is no difference in the ability of killing Enterococcus faecalis between them. For the performance of the two in the bacteriostasis index, it is impossible to draw a clear conclusion which has the same meaning as if or not from the data obtained at present.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.05

【参考文献】