血管扩张剂治疗突发性耳聋的系统评价

发布时间：2019-01-03 21:44

【摘要】： 目的:评价血管扩张剂治疗突发性耳聋的疗效及其安全性。方法:根据循证医学原则,运用系统评价的方法,计算机检索Cochrane图书馆(2009年第三期),PubMed(1966-2009),EMbase(1974-2009),ISI Proceedings(1997-2009)、中国生物医学文献数据库(1978-2009),中国学术期刊全文数据库(1979-2009)、VIP中文科技期刊全文数据库(1989-2009)、万方数据库和Google学术检索。检索时间截至2009年9月。首先研究者阅读文献题目,对相关联的文献再阅读其摘要,如果是随机对照试验则阅读全文,选择符合纳入标准的随机对照试验(RCT),根据制定的数据表提取符合纳入标准的研究数据,对纳入研究的特点列表分析,方法学质量评价从随机方法、分配隐藏、盲法、有无失访这几方面采用Jadad评分和分配方案隐藏分级进行评价,采用RevMan4.2.10软件进行统计分析。对于可以合并分析的指标进行Meta分析;对于不能进行Meta分析则用描述性方法分析结果。研究结果是连续性变量的研究采用标准均数差(SMD)或加权均数差(WMD)表示,研究结果是二分类变量的研究采用比值比(OR)或相对危险度(RR)表示,两者都计算95%的可信区间(CI)。对无统计学异质性的研究,用固定效应模型合并分析;对有统计学异质性的研究,用随机效应模型处理。结果:共28个试验符合纳入标准。纳入研究中血管扩张剂涉及的药物包括低右、羟已基淀粉、前列腺素、已酮可可碱、萘呋胺脂、复方丹参、葛根素、银杏叶提取物等。本系统评价结果显示,血管扩张剂与安慰剂对照的7个试验,血管扩张剂疗效并不优于安慰剂。血管扩张剂和血管扩张剂比较的14个试验中,葛根素注射液与其他血管扩张剂疗效比较有统计学意义,银杏叶提取物疗效不优于其他血管扩张剂,低右+复方丹参不优于其他血管扩张剂,低右的短期疗效和长期疗效都不优于羟己基淀粉,萘呋胺脂疗效不优于其他血管扩张剂。血管扩张剂对比其他治疗方法9个试验,复方丹参不优于其他治疗,血管扩张剂疗效不优于激素。28个试验中8个试验描述了瘙痒、过敏反应、高血压、心律失常、头痛、出汗等不良反应。结论:血管扩张剂治疗突发性耳聋的疗效仍不清楚,由于上述的结论基本来自单个研究,研究质量参差不齐,大多数研究样本量小,因此使用结论时必须谨慎,所有研究结果均不能作为推荐应用的证据,有必要进行更多多中心、试验设计严格、大规模的随机对照试验。目前尚无足够的证据证明哪种药物更有效,期待开展更多多中心、大样本、长期随访的RCT,以提供更可靠的证据。
[Abstract]:Objective: to evaluate the efficacy and safety of vasodilators in the treatment of sudden deafness. Methods: according to the principle of evidence-based medicine, the Cochrane library was searched by computer using the method of systematic evaluation (), PubMed (1966-2009), EMbase (1974-2009), ISI Proceedings (1997-2009). China Biomedical Literature Database (1978-2009), Chinese academic Journals Full-text Database (1979-2009), VIP full text Database), Wanfang Database and Google academic Retrieval. Search time as of September 2009. First, the researchers read the title of the literature, and then read the abstract of the related literature. If it is a randomized controlled trial, read the full text, and select the (RCT), that meets the inclusion criteria. According to the data table to extract the research data according to the inclusion criteria, to analyze the characteristics of the included research, the evaluation of methodology quality from random methods, distribution hiding, blind method, The Jadad score and the hidden grading of the distribution scheme are used to evaluate the missing visits, and the statistical analysis is carried out by RevMan4.2.10 software. The Meta analysis is used for the indexes that can be combined and the results are analyzed by descriptive method for the indexes that can not be analyzed by Meta. The result of the study is that the continuous variable is expressed by standard mean difference (SMD) or weighted mean difference (WMD). The result of the study is that the ratio (OR) or the relative risk (RR) of the two classification variables are used. Both calculate 95% confidence interval (CI). For the study of no statistical heterogeneity, the fixed effect model is used to combine the analysis, and the random effect model is used to deal with the study of statistical heterogeneity. Results: a total of 28 trials met the inclusion criteria. The drugs involved in the study include low-right, hydroxyhexyl starch, prostaglandin, pentoxifylline, naphthoxime, compound salvia miltiorrhiza, puerarin, ginkgo biloba extract and so on. The results showed that vasodilators were not superior to placebo in 7 trials. In 14 experiments of comparing vasodilators and vasodilators, puerarin injection had statistical significance compared with other vasodilators, and Ginkgo biloba extract was no better than other vasodilators. The low-right compound salvia miltiorrhiza is not superior to other vasodilators, the short-term and long-term effects of low-right salvia miltiorrhiza are not better than that of hydroxyhexyl starch, and the efficacy of naphthylamine is not better than that of other vasodilators. The effects of compound salvia miltiorrhiza and vasodilators were not superior to those of hormones. Eight of 28 trials described itching, allergic reactions, hypertension, arrhythmia, headache, Adverse reactions such as sweating. Conclusion: the efficacy of vasodilators in the treatment of sudden deafness is still unclear. Since the above conclusions come from a single study, the quality of the study is uneven, and the sample size of most studies is small. None of the results can be used as evidence for recommended applications. More centers, well-designed, large-scale randomized controlled trials are needed. There is not enough evidence to prove which drugs are more effective, and more centers, large samples, and long-term follow-up of RCT, are expected to provide more reliable evidence.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764.43

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