针刀治疗股骨头缺血性坏死的meta分析与临床诊疗操作推荐方案的文献研究

发布时间：2018-05-30 01:07

本文选题：针刀 + 股骨头缺血性坏死　；参考：《广西中医药大学》2017年硕士论文

【摘要】：目的:通过应用循证医学的方法和临床指南的方法,将全数据库收集到的高质量数据与专家咨询稿整理的数据进行整合,以此为基础编写出《针刀治疗股骨头缺血性坏死临床诊疗操作方案推荐方案》。以提高临床针刀医生治疗股骨头缺血性坏死的诊疗效率,减少诊疗事故,为推动针刀治疗股骨头缺血坏死的科学化、规范化和标准化研究提供借鉴。方法:本次研究是基于循证医学方法中的meta分析和证据分级法,结合专家共识法和统计学的频数法共同完成的。Meta分析方法:应用循证医学的方法明确所要研究的临床问题,依据临床问题在PICO的原则下制定出检索词和检索式,将检索词和检索式输入数据库,进行全数据库检索,检索时力争做到检索的“全”而“准”。将检索到的数据输入EndnoteX7文献管理软件中进行去重,将符合纳入标准的文献按照Jadad质量评分标准进行评分,最终共纳入11篇符合纳入标准的高质量文献;提取高质量文献数据,将数据输入Review Manager5.2统计学软件进行统计学分析,通过森林图和倒漏斗图的分析,比较针刀组与对照组治疗股骨头缺血性坏死总疗效、Harris评分和骨内压的差异。临床诊疗推荐方案方法:采用OCEBM证据分级标准表对检索到的证据进行评价分级,共获得11篇A级证据。通过对高质量证据中数据的提取,选取频数高的数据,参照《WHO西太区循证针灸临床实践指南推荐方案专家意见表》的格式编写成《针刀治疗股骨头缺血性坏死临床诊疗操作推荐方案(初稿)》。参考专家共识的方法针对性的对《针刀治疗股骨头缺血性坏死临床诊疗操作推荐方案(初稿)》中存在的分歧编写成《针刀治疗股骨头缺血性坏死临床诊疗操作推荐方案(专家咨询稿)》。通过《针刀治疗股骨头缺血性坏死临床诊疗操作推荐方案(专家咨询稿)》的发放、回收,并将收集到的数据采用Microsoft Excel软件进行频数分析,并绘制出数据统计图;最终将专家咨询稿数据与《针刀治疗股骨头缺血性坏死临床诊疗操作推荐方案(初稿)》进行数据整合,使初稿中存在的分歧达成一致的结论,如仍存有部分分歧则再次通过咨询专家的方式协商解决。结果:1、meta分析结果:(1)总有效率meta分析异质性检验Chi2=16.42,自由度(df)=7时,P=0.02,I2=57%,P0.1拒绝H0,接受H1,统计学分析差异有统计学意义;合并效应检验Z=3.06,P=0.002,P0.05拒绝H0,接受H1,统计学分析差异有统计学意义,总效应95%CI=3.94[1.46,9.49]。(2)亚组Harris评分meta分析异质性检验Chi2=5.36,自由度(df)=1时,P=0.02,I2=81%,P0.1拒绝H0,接受H1,统计学分析差异有统计学意义;合并效应检验Z=2.96,P=0.003,P拒绝H0,接受H1,统计学分析差异有统计学意义,总效应的95%CI=6.12[2.06,10.17]。(3)骨内压meta分析异质性检验Chi2=12.28,自由度(df)=2时,P=0.02,I2=84%,P0.1拒绝H0,接受H1,统计学分析差异有统计学意义;合并效应两检验Z=0.72,P=0.47,P0.05拒绝H1,接受H0,统计学分析差异无统计学意义。2、将《针刀治疗股骨头缺血性坏死临床诊疗操作推荐方案(初稿)》和针刀治疗股骨头缺血性坏死临床诊疗操作推荐方案(专家咨询稿)》数据整合后编写成了《针刀治疗股骨头缺血性坏死临床诊疗操作推荐方案》结论:1、通过对针刀治疗股骨头缺血性坏死的meta分析验证了针刀治疗股骨头缺血性坏死是有效的。2、通过《针刀治疗股骨头缺血坏死的临床诊疗操作推荐方案(初稿)》数据和《针刀治疗股骨头缺血坏死的临床诊疗操作推荐方案(专家咨询稿)》数据的整合最终完成了《针刀治疗股骨头缺血坏死的临床诊疗操作推荐方案》,为临床医生针刀治疗股骨头缺血性坏死提供了一定的指导和参考价值。3、本次的研究是在遵循循证医学的方法结合专家共识的方式完成针刀治疗股骨头缺血性坏死的标准化诊疗方案的编写尝试,同样也为今后针刀诊疗操作的标准化研究提供一定的参考意义和方法学借鉴。
[Abstract]:Objective: to integrate the high quality data collected by the whole database and the data collected by expert consultation by using the method of evidence-based medicine and the method of clinical guide, so as to prepare a proposal for the treatment of the clinical diagnosis and treatment of avascular necrosis of the femoral head by Acupotomy. The diagnosis and treatment efficiency of bloody necrosis and the reduction of diagnosis and treatment accidents will provide a reference for the scientific, standardized and standardized research of acupotomy for the treatment of avascular necrosis of the femoral head. Method: This study is based on the meta analysis and the evidence classification method in the evidence-based medicine method, combined with the expert consensus method and the statistical frequency method to complete the.Meta analysis side. Method: the method of evidence-based medicine is used to clarify the clinical problems to be studied. According to the clinical problems, the retrieval words and retrieval forms are formulated under the principle of PICO. The retrieval words and retrieval types are entered into the database for full database retrieval, and the "complete" and "quasi" of the retrieval is achieved when the retrieval is retrieved. The retrieved data is entered into the EndnoteX7 document management. The software is carried out in the software, and the documents which conform to the standard are scored according to the Jadad quality standard, and 11 high quality documents are included in the literature. The high quality literature data is extracted and the data are entered into Review Manager5.2 statistics software for statistical analysis, and the comparison needle is compared through the analysis of the forest map and the funnel plot. The total curative effect of avascular necrosis of the femoral head and the difference between the Harris score and the internal pressure in the treatment of the avascular necrosis of the femoral head. The recommendation scheme of the clinical diagnosis and treatment: the evaluation and classification of the retrieved evidence by the OCEBM evidence classification standard table, and a total of 11 A-level evidence were obtained. The high frequency data were selected by the extraction of the high quality evidence and the reference to . Reference expert consensus method pertinent to the disagreement in the clinical treatment recommendation scheme (preliminary draft) of acupotomy for avascular necrosis of the femoral head (first draft) > The clinical diagnosis and treatment recommendations (expert consultation) of acupotomy for avascular necrosis of the femoral head (expert consultation) >. The issuance of the recommendation scheme (expert consultation) for the treatment of avascular necrosis of the femoral head by acupotomy, recovery, and the data collected by the Microsoft Excel software for frequency analysis and data Statistics Figure; finally, integrate the expert consultation data with the Acupotomy treatment for the clinical diagnosis and treatment of avascular necrosis of the femoral head (first draft), to make the conclusion of the differences in the first draft, if there are still some differences in the way of consulting experts to solve them again. Results: 1, the results of meta analysis: (1) the total efficiency of meta Analysis of heterogeneity test Chi2=16.42, degree of freedom (DF) =7, P=0.02, I2=57%, P0.1 refuse H0, accept H1, statistical analysis difference is statistically significant; the combination effect test Z=3.06, P=0.002, P0.05 H0, statistical analysis difference is statistically significant, total effect (2) subgroup Chi2=5.36, degree of freedom (DF) =1, P=0.02, I2=81%, P0.1 refuse H0, accept H1, statistical analysis difference is statistically significant; the combination effect test Z=2.96, P=0.003, P H0, statistical analysis difference is statistically significant, total effect (3) intrabone pressure analysis heterogeneity test, freedom degree At the time, P=0.02, I2=84%, P0.1 refused H0, accepted H1, and statistical analysis was statistically significant; combined effect two test Z=0.72, P=0.47, P0.05 refused H1, accepted H0, and statistical analysis was not statistically significant.2, "Acupotomy for the treatment of avascular necrosis of the femoral head (first draft) > and Acupotomy for avascular necrosis of the femoral head." Clinical diagnosis and treatment operation recommendation scheme (expert consultation) > data integration was compiled into < needle knife treatment of femoral head avascular necrosis of clinical diagnosis and treatment scheme > conclusion: 1, through the needle knife treatment of avascular necrosis of the femoral head meta analysis verifies that Acupotomy for ischemic necrosis of the femoral head is an effective.2, through the "needle knife treatment of femoral head" Recommendations for clinical diagnosis and treatment of ischemic necrosis (preliminary draft) > data and < needle knife treatment for clinical diagnosis and treatment of femoral head ischemic necrosis (expert consultation) > data integration finally complete the clinical diagnosis and treatment recommendation of acupotomy for avascular necrosis of the femoral head, for the treatment of avascular necrosis of the femoral head by a clinician. It provides a certain guide and reference value.3. This study is to follow the method of evidence-based medicine combined with expert consensus to complete the preparation of a standardized treatment scheme for Acupotomy for avascular necrosis of the femoral head. It also provides some reference and methodology for the standardization of needle knife diagnosis and treatment in the future.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

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