不同下颌前伸度口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征的系统评价

发布时间：2018-10-14 20:30

【摘要】：目的:评价不同下颌前伸度的口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea and hyponea syndrome,OSAHS)的临床疗效。方法:计算机检索Pub Med、Embase、Cochrane图书馆、CNKI、维普和万方等数据库,纳入不同下颌前伸度的口腔矫治器治疗OSAHS的随机对照试验(randomized clinical trials,RCT)和前后对照试验(before-after trials,BAT),对其进行质量评价并提取资料,用Rev Man 5.3软件进行meta分析。结果:纳入2个RCT、2个采用了随机方法的BAT和3个非随机BAT,共244例患者。根据方法学质量评价及各试验设计情况,对其中4篇高质量研究进行meta分析,结果显示,下颌前伸量达到下颌最大前伸度(maximal mandibular advancement,MMA)50%与75%两组的治疗有效率[呼吸暂停低通气指数(apnea hypopnea index,AHI)或氧减指数(oxygen desaturation index,ODI)降低50%]比较,I2=0%,合并效应量RR值为0.93,95%CI为0.80~1.09;两组的治愈率(AHI或ODI10次/h)比较,I2=45%,合并效应量RR值为0.85,95%CI为0.68~1.06,证据尚不足以证明两组的治疗有效率和治愈率有差异。亚组分析提示病情严重程度可能是影响治愈率的重要因素。结论:对于OSAHS患者,在一定范围内下颌前伸度增加有利于提高治疗有效率和治愈率,但尚缺乏足够证据证明75%MMA优于50%MMA;轻症患者治愈率高于重症。
[Abstract]:Objective: to evaluate the clinical effect of oral appliance with different mandibular extension on obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea and hyponea syndrome,OSAHS). Methods: the Pub Med,Embase,Cochrane library, CNKI, Weip and Wanfang databases were searched on the computer, and were included in the randomized controlled trial (randomized clinical trials,RCT) and the antecedent controlled trial (before-after trials,BAT) for the treatment of OSAHS with different mandibular protrusions. The quality of the data was evaluated and the data were extracted. Meta analysis was carried out with Rev Man 5.3 software. Results: 2 cases of BAT and 3 cases of non-random BAT, were included in 2 RCT, patients. According to the evaluation of methodology quality and the design of each experiment, meta analysis was carried out on four of the high quality studies. The results showed that, The effective rate of 50% mandibular protruding volume to the maximum mandibular protruding degree (maximal mandibular advancement,MMA) was 50% lower than that of 75% group [apnea hypopnea index (apnea hypopnea index,AHI) or oxygen reduction index (oxygen desaturation index,ODI) was reduced by 50%], and the combined effect RR value was 0.93% 95% CI was 0.80 卤1.09; the cure rate of both groups was 0.80 卤1.09. The rate (AHI or ODI10 times / h), I _ 2N _ (45) and the combined effect volume (RR) were 0.85 ~ 95 CI = 0.681.06. The evidence was not enough to prove the difference between the two groups in the effective rate and cure rate. Subgroup analysis suggested that the severity of the disease may be an important factor affecting the cure rate. Conclusion: for patients with OSAHS, the increase of mandibular extension in a certain range is helpful to improve the effective rate and cure rate, but there is still insufficient evidence to prove that 75%MMA is better than 50MMA, and the cure rate of mild patients is higher than that of severe patients.
【作者单位】：北京大学口腔医学院·口腔医院正畸科口腔数字化医疗技术和材料国家工程实验室口腔数字医学北京市重点实验室;
【基金】：国家自然科学基金(81470272) 北京大学医工结合建设项目基金(BMU20140397)资助~~
【分类号】：R766;R783.5

【相似文献】