關節(jié)腔內注射利多卡因與靜脈麻醉在急性肩關節(jié)前脫位中的應用-Meta分析
發(fā)布時間：2018-12-12 21:10
【摘要】：背景：肩關節(jié)脫位占全身關節(jié)脫位的40%以上,是骨科急診最常見的疾病之一。其社區(qū)發(fā)病率為每年每十萬人口中發(fā)生11.2例。雖然早在2000年前,醫(yī)學之父希波克拉底便詳細描述了肩關節(jié)的解剖以及脫位類型和閉合復位的方法。迄今為止,人們對于如何治療外傷性肩關節(jié)脫位仍缺乏共識。調查研究顯示,國內大多數(shù)醫(yī)生認為在進行手法復位時需要采取合適的麻醉方式,且選擇最多的3種麻醉方式依次為：①臂叢神經(jīng)阻滯；②靜脈麻醉；③關節(jié)腔內注射利多卡因麻醉法。臂叢神經(jīng)阻滯位點周圍解剖結構復雜,操作難度較高且并發(fā)癥多見。因此,靜脈麻醉成為了國外醫(yī)生在肩關節(jié)脫位手法復位麻醉方式中的首選。然而,近年來關節(jié)腔內注射利多卡因的麻醉方式以其操作簡單,并發(fā)癥少,治療費用低等優(yōu)勢逐漸走進了人們的研究視野。雖然國外開展了大量關于靜脈麻醉與關節(jié)腔內注射利多卡因麻醉法的隨機對照試驗。然而對于其確切療效,結果仍存在部分爭議。 目的：本研究將通過Meta分析的方式,對國內外有關靜脈麻醉以及關節(jié)腔內注射利多卡因麻醉方式的臨床研究展開深入的整合分析。針對兩種麻醉方式各自的優(yōu)勢,結合高質量的隨機對照試驗研究,試圖得到關于兩者在肩關節(jié)脫位手法復位中應用價值的更為強有力的證據(jù),為臨床治療決策提供幫助。 方法：計算機檢索MEDLINE(1950至2013),EMBASE(1980至2013)及CENTRAL (Cochrane Central Register of Controlled Trials,最新版),以"shoulder dislocation, lidocaine or lignocaine, intra-articular"為英文檢索詞,結合Cochrane協(xié)作網(wǎng)推薦使用的針對MEDLINE隨機對照試驗的高敏感性檢索策略進行檢索。根據(jù)文章題名及摘要進行初篩,對符合要求的文獻獲取全文進一步篩查。質量評價采用Cochrane協(xié)作網(wǎng)推薦的偏倚風險評價工具,納入文獻的質量越高,Meta分析的結果可信度越高。根據(jù)所納入文獻的異質性高低選擇使用固定效應模型或隨機效應模型分析數(shù)據(jù)。本研究使用的軟件為Ravman5.2版本。 結果：經(jīng)過對1539篇文章進行初篩后,我們對剩下的11篇文章進行了全文篩選.最后排除4篇文獻,納入7篇隨機對照試驗.總共有317名患者符合納入條件。關節(jié)腔內注射利多卡因組在復位成功率、復位中患者的主觀疼痛體驗以及復位3-4次后的成功率上與靜脈麻醉組均無明顯差異。而在并發(fā)癥的發(fā)生率以及院內治療時間上,關節(jié)腔內注射利多卡因麻醉組明顯優(yōu)于靜脈麻醉組。且在復位1-2次后的成功率這個指標上關節(jié)腔內注射利多卡因組也表現(xiàn)出了明顯的優(yōu)勢。 結論：關節(jié)腔內注射利多卡因麻醉法在復位療效以及疼痛控制上與靜脈麻醉相當,但其并發(fā)癥更少,費用更低,需要的治療時間更短。
[Abstract]:Background: shoulder dislocation, which accounts for more than 40% of the total dislocation, is one of the most common diseases in orthopedic department. The community incidence rate is 11.2 per 100,000 population per year. Although Hippocrates, the father of medicine, described in detail the anatomy of the shoulder joint, the type of dislocation and the method of closed reduction as early as 2000 years ago. So far, there is still a lack of consensus on how to treat traumatic dislocation of the shoulder. The investigation shows that most doctors in China think that the appropriate anesthesia should be adopted when performing manual reduction, and the three most selected anesthesia methods are as follows: (1) brachial plexus block; (2) intravenous anesthesia; 3 intraarticular injection of lidocaine. The anatomic structure around the block site of brachial plexus is complex, the operation is difficult and the complications are common. Therefore, intravenous anesthesia has become the first choice for foreign doctors in manual reduction anesthesia of shoulder dislocation. However, in recent years, the intraarticular injection of lidocaine has gradually come into the research field because of its advantages of simple operation, less complications and low treatment cost. A large number of randomized controlled trials of intravenous anesthesia and intraarticular lidocaine anesthesia have been conducted abroad. However, there are still some controversies about the exact effect. Objective: to analyze the clinical study of intravenous anesthesia and intraarticular lidocaine by Meta analysis. According to the advantages of the two anaesthesia methods, combined with a high quality randomized controlled trial, we try to obtain more powerful evidence about the application value of the two methods in the manual reduction of shoulder dislocation, so as to provide help for the clinical treatment decision. Methods: MEDLINE (from 1950 to 2013), EMBASE (1980 to 2013) and the latest edition of CENTRAL (Cochrane Central Register of Controlled Trials, were searched by computer. "shoulder dislocation, lidocaine or lignocaine, intra-articular" was used as the key word in English. A highly sensitive search strategy for MEDLINE randomized controlled trials recommended by Cochrane Cooperative Network is used. According to the title and abstract of the article, the full text of the document obtained in accordance with the requirements was screened further. The bias risk assessment tool recommended by Cochrane Cooperative Network was used in the quality evaluation. The higher the quality of the literature included, the higher the reliability of the results of the Meta analysis. A fixed effect model or a random effect model is used to analyze the data according to the heterogeneity of the literature involved. The software used in this study is Ravman5.2 version. Results: after screening 1539 articles, we screened the remaining 11 articles. Finally, 4 articles were excluded and 7 randomized controlled trials were included. A total of 317 patients were eligible for inclusion. There was no significant difference in the success rate of reduction, the experience of subjective pain and the success rate after 3-4 times of reduction between the group of intraarticular injection of lidocaine and the group of intravenous anesthesia. In the incidence of complications and hospital treatment time, intraarticular injection of lidocaine anesthesia group was significantly better than intravenous anesthesia group. The success rate of the upper articular injection of lidocaine also showed obvious advantages after 1-2 times reduction. Conclusion: intraarticular lidocaine anesthesia is comparable to intravenous anesthesia in terms of reduction efficacy and pain control, but it has fewer complications, lower cost and shorter treatment time.
【學位授予單位】：華中科技大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R684.7;R614
本文編號：2375251
[Abstract]:Background: shoulder dislocation, which accounts for more than 40% of the total dislocation, is one of the most common diseases in orthopedic department. The community incidence rate is 11.2 per 100,000 population per year. Although Hippocrates, the father of medicine, described in detail the anatomy of the shoulder joint, the type of dislocation and the method of closed reduction as early as 2000 years ago. So far, there is still a lack of consensus on how to treat traumatic dislocation of the shoulder. The investigation shows that most doctors in China think that the appropriate anesthesia should be adopted when performing manual reduction, and the three most selected anesthesia methods are as follows: (1) brachial plexus block; (2) intravenous anesthesia; 3 intraarticular injection of lidocaine. The anatomic structure around the block site of brachial plexus is complex, the operation is difficult and the complications are common. Therefore, intravenous anesthesia has become the first choice for foreign doctors in manual reduction anesthesia of shoulder dislocation. However, in recent years, the intraarticular injection of lidocaine has gradually come into the research field because of its advantages of simple operation, less complications and low treatment cost. A large number of randomized controlled trials of intravenous anesthesia and intraarticular lidocaine anesthesia have been conducted abroad. However, there are still some controversies about the exact effect. Objective: to analyze the clinical study of intravenous anesthesia and intraarticular lidocaine by Meta analysis. According to the advantages of the two anaesthesia methods, combined with a high quality randomized controlled trial, we try to obtain more powerful evidence about the application value of the two methods in the manual reduction of shoulder dislocation, so as to provide help for the clinical treatment decision. Methods: MEDLINE (from 1950 to 2013), EMBASE (1980 to 2013) and the latest edition of CENTRAL (Cochrane Central Register of Controlled Trials, were searched by computer. "shoulder dislocation, lidocaine or lignocaine, intra-articular" was used as the key word in English. A highly sensitive search strategy for MEDLINE randomized controlled trials recommended by Cochrane Cooperative Network is used. According to the title and abstract of the article, the full text of the document obtained in accordance with the requirements was screened further. The bias risk assessment tool recommended by Cochrane Cooperative Network was used in the quality evaluation. The higher the quality of the literature included, the higher the reliability of the results of the Meta analysis. A fixed effect model or a random effect model is used to analyze the data according to the heterogeneity of the literature involved. The software used in this study is Ravman5.2 version. Results: after screening 1539 articles, we screened the remaining 11 articles. Finally, 4 articles were excluded and 7 randomized controlled trials were included. A total of 317 patients were eligible for inclusion. There was no significant difference in the success rate of reduction, the experience of subjective pain and the success rate after 3-4 times of reduction between the group of intraarticular injection of lidocaine and the group of intravenous anesthesia. In the incidence of complications and hospital treatment time, intraarticular injection of lidocaine anesthesia group was significantly better than intravenous anesthesia group. The success rate of the upper articular injection of lidocaine also showed obvious advantages after 1-2 times reduction. Conclusion: intraarticular lidocaine anesthesia is comparable to intravenous anesthesia in terms of reduction efficacy and pain control, but it has fewer complications, lower cost and shorter treatment time.
【學位授予單位】：華中科技大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R684.7;R614
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