循证医学治疗性案例分析课件.docVIP

循证医学实践 教学 案例分析 2014 年 2 月 18 日修訂 初诊日期 ：2013 年 1 月 科別:口腔正畸科 住院号 :38871 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， IST 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: IST 矫治器 O: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 treatment SUMMARY Various types of mandibular protrusive appliances have revealed di ? erent treatment success in mild-to-moderate obstructive sleep apnoea (OSA). The present study compared the long-term e ? ect of two di ? erent 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 a short-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 signi?cant improvement in the short-term evaluation with both appliances, but the TAP appliance revealed a signi?cantly greater e ? ect. After more than 2 years of treatment, sleep outcomes revealed an equal e? ect with both appliances. The subjective bene?ts achieved initially lessened signi?cantly. This study illustrates that both the ISTand the TAP appliances are e?ective therapeutic devices for OSA after a period of over 24 months. Lack of compliance may be due to insu ? cient improvement in anticipated subjective symptoms and ? or a recurrence of symptoms over time. 证据评价 (Appraisal ) 证