资源描述
科別：口腔正畸科住院号:38871初诊日期2013年1月报告者姓名：职务：住院医师基地医师实习医师完成时间：2014.4.12病例摘要黄某，男，21岁。初诊日期：2013年1月；结束时间：2014年4月。主诉：夜间睡眠打鼾憋气5年。诊断：骨性II类，牙性II类，轻度睡眠呼吸暂停综合征矫治设计：正畸治疗，1ST矫治器初期：效果不佳，改用TAP矫治器效果：1.睡眠呼吸暂停症状彻底解除。2.上下颌牙齿排齐整平，前牙覆牙合、覆盖正常， 中线对齐，磨牙、尖牙关系中性，侧貌有所改善。提出可回答的临床问題(Asking)P:轻中度OSAHS患者I: TAP矫治器C: 1ST矫治器0:治疗效果提高检索最有用的证据(Acquire)关键词(Key word )： OSAHS， oral appliances数据库来源(Database )： PubMed Clinical Queries主要內容：A randomized prospective long-term study of two oral appliances for sleep apnoea treatmentSUMMARY Various types of mandibular protrusive appliances have revealed different treatment success in mild-to-moderate obstructive sleep apnoea (OSA). The present study compared the long-term effect of two different appliances in the treatment of OSA. A total of 103 patients with OSA were randomized and treated with an ISTor Thornton Anterior Positioner (TAP) appliance. They were followed-up after ashort-term treatment period of 6 months and long-term treatment period of over 24 months. Sleep studies in the sleep laboratory were conducted with and without the appliances, and various questionnaires assessing subjective daytime sleepiness, sleep quality, quality of life and symptom scores were administered at each time interval. Quality of life, sleep quality, sleepiness, symptoms and sleep outcome showed significant improvement in the short-term evaluation with both appliances, but the TAP appliance revealed a significantly greater effect.After more than 2 years of treatment, sleep outcomes revealed an equal effect with both appliances. The subjective benefits achieved initially lessened significantly. This study illustrates that both the ISTand theTAPappliances are effective therapeutic devices for OSA after a period of over 24months. Lack of compliance may be due to insufficient improvement in anticipated subjective symptoms and / or a recurrence of symptoms over time.证据评价(Appraisal )证据等級：A级Worksheet:一、真实性随机分组，隐藏措施(计算机随机)，基线一致，short-term时间短，失访率低，long-termT2 随访时间长，失访率高，无具体指出而是引用其他文献方法，可推测ITT，采用盲法，测 量指标客观，基础治疗一致二、强度与精度：1. short-term：P 0.05, P 0.001 compared without the appliance，P 0.05 1ST appliance versus TAP appliance. 1ST appliance: n = 47; TAP appliances: n = 48.Values are means SD, medians (quartiles ranges).2. long-term：Significant with the device compared without it，significant comparison between T1 and T2, significant comparison between IST appliance and TAP appliance, IST : n = 24, TAP: n = 21.Values are means SD, medians (quartiles ranges)三、实用性1 .研究对象：Patients were recruited between July 2001 and December 2003 through the sleep laboratory of the department of Respiratory Care at the University Hospital of Freiburg (Germany) (17 females and 86 males; age: 55.5 10.6 years, body mass index (BMI): 25.9 2.9 kg/ m2) 存在社会人口学差异2. 可行性好3. 无危险性评估4. 结合病人期望，爱好，病人决定治疗三 *=UO-WOOQV1 03 pacienis raudomizBd to treatm-ent51 paticnis allo cat cd lo 1STsappli.Lin.ce4 wiLlidrew from s-Luily52 patients a located to TAP appliance让hdrev from study547 included in T I an alysis2=4-cnpl ete resp mierl利 pariiaL respfinler5 non - responder4S inclu ded in Tl an alysds3SJ cdEnpli亡 respcindtr 呂 par t l aL re ApCi rld ost oi fo 1 ow u p3 wiilid匚已片暮 co use nt22 withdrew from treatment=尝1L micting dcriLal inc jsion criLOria 斗 siructura pharyngcal obsirucri on6 refus-ed ro parr i ci pare证据解读及证据应用（Apply ）随着社会经济的发展，阻塞性睡眠呼吸暂停低通气综合征（OSAHS ）发病率有明显增长的 趋势。OSAHS以睡眠期间上气道反复发生阻塞为特征，引起呼吸暂停，低通气及睡眠紊乱，一 般表现为睡眠打鼾、低氧血症及白天嗜睡等。有三大主要治疗方法，一、持续正压通气治疗（呼 吸机）。二、手术治疗：如扁桃体腺样体摘除、鼻腔手术，舌咽成形术及口腔正颌手术等。三、 口腔矫治器治疗：口腔矫治器适用于单纯鼾症患者及轻、中度OSAHS患者。另外，对那些拒 绝或无法耐受呼吸机治疗或经手术治疗后复发的患者，口腔矫治器是一种较好的选择。矫治器 种类很多，其中TAP矫治器短期效果好，但长期来看1ST和TAP矫治器都有较好的疗效。自我评估与改善（Audit ）此文章存在的最明显的不足在分析数据时没有简明指出方法，95%CI等。 另外由于英语阅读能力还不够，部分内容没看懂，改善重在多读文献！教師（各科窗口）批註及簽名：备注（专业文档是经验性极强的领域，无法思考和涵盖全面，素材和资料部分来自网络，供参考。 可复制、编制，期待你的好评与关注）
展开阅读全文