糖皮质激素预防麻醉后咽喉部并发症的系统评价

发布时间：2018-07-21 19:53

【摘要】：目的：评估糖皮质激素对建立人工气道后咽喉部并发症预防作用的有效性及安全性。方法：计算机检索了英文数据库：EMBASE、PubMed、ISI Web of Knowledge、The CochraneLibrary；中文数据库：中国生物医学数据库、万方数据库、维普数据库、中国知网数据库，同时手工检索了相关研究的参考文献。查找局部或全身使用激素与安慰剂或空白对照组相比，预防建立人工气道后咽喉部并发症的随机对照试验。本研究的建立人工气道后咽喉部并发症包括咽喉痛、声嘶、咳嗽。由两个研究者根据纳入和排除标准独立筛选文献，评估研究质量及偏倚风险情况，并应用RevMan5.2软件进行Meta分析。结果：共纳入19个随机对照试验，共有2084例个病例，其中激素组1241例，对照组843例。激素可降低术后咽喉痛、声嘶、咳嗽的发病率，术后1-3小时（hour，h）的相对危险度（relativerisk，，RR）值及95%的置信区间（confidence interval，CI）分别为0.50[0.37,0.67]、0.43[0.30,0.61]、0.55[0.35,0.88]，需要防治的病例数（number needed to treat，NNT）分别为4.0、3.9、7.9；术后24h的RR值及95%CI分别为0.51[0.43,0.60]、0.58[0.48,0.70]、0.42[0.22,0.82]，NNT分别为5.5、5.6、5.6。同时糖皮质激素也降低术后咽喉痛的程度，1-3h、24h的标准化均数差分别为-1.47[-1.85,-1.09]、-0.97[-1.40,-0.53]，在糖皮质激素的不良反应上，仅2个研究有描述，且未发现糖皮质激素相关不良反应，其余均未报告。结论：使用糖皮质激素可降低成人建立人工气道后咽喉部并发症的发病率，且用药途径可对糖皮质激素的预防效果产生影响，局部用药效果优于全身用药。
[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 卤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.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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