【精品PPT】实证医学竞赛-CAT摘要

實證醫學競賽－CAT摘要(zhāiyào)組別：第(A)組第一页，共27页。訂定PICOP:acutepancreatitiswithabdominalpainI:PerscriptionofdrugsC:Morphine,demerol,otheranalgesicsO:Efficacyofpaincontrol第二页，共27页。資料庫來源1.Pubmed2.MedlineOvid3.Uptodate4.Googlescholar第三页，共27页。搜尋之關鍵字1.Pancreatitisandpainmanagement2.Pancreatitisandmorphine3.Pancreatitisand“demerolormeperidineorpethidine”第四页，共27页。搜尋之歷程請列出你們搜尋的歷程。第五页，共27页。文獻研讀1.Efficacyandtoleranceofmetamizoleversusmorphineforacutepancreatitispain.PeiróAM,MartínezJ,MartínezE,deMadariaE,LlorensP,HorgaJF,Pérez-MateoM.Pancreatology.2008;8(1):25-9.Epub2008Jan31.PMID:18235213[PubMed-indexedforMEDLINE]2.AmJGastroenterol.2001Apr;96(4):1266-72.NarcoticanalgesiceffectsonthesphincterofOddi:areviewofthedataandtherapeuticimplicationsintreatingpancreatitis.ThompsonDR.DepartmentofInternalMedicine,BaylorUniversityMedicalCenter,Dallas,Texas75246,USA.第六页，共27页。Efficacyandtoleranceofmetamizoleversusmorphineforacutepancreatitispain.AbstractBackground/Aims:Morphinehasbeencontraindicatedforpaintreatmentinacutepancreatitisbecauseofitspresumedopioid-inducedsphincterofOddidysfunction.However,scientificevidencesupportingadeleteriousinfluenceontheclinicalcourseisabsent.Thispilotstudywasundertakentoevaluatetheefficacyandadverseeventsofmetamizoleversusmorphineinacutepancreatitis.Methods:16patientswithacutepancreatitiswererandomizedtoreceive10mg/4hs.c.(n=8)morphineor2g/8hi.v.(n=8)metamizole.Painscoreswererecordedevery4hduring48hafteradmissionbyaVisualAnalogueScale.Pethidinewasadditionallyadministeredasarescuetherapy.Results:75%ofpatientsachievedpainreliefinthemetamizolegroupversus37.5%inthemorphinegroupwithin24hofhospitalization(6/8vs.3/8;p:n.s.).Themeantimetoachievepainreliefwasshorterinthemetamizolegroup(1086.6vs.17818.3h;p:n.s.).Attheendofthestudy,75%ofpatientsachievedpainreliefinthemetamizolegroupversus50%inthemorphinegroup.Threepatientsineachgroupneededpethidine:2outof3achievedpaincontrolinthemetamizolegroupvs.0outof3inthemorphinegroup.Conclusions:Intravenousmetamizoleshowsanon-significantassociationwithaquickerpainreliefthanmorphines.c.inacutepancreatitis.Alargerrandomizedcontrolledtrialshouldbedesirabletoconfirmthisresult.第七页，共27页。第八页，共27页。NarcoticanalgesiceffectsonthesphincterofOddi:areviewofthedataandtherapeuticimplicationsintreatingpancreatitis.AmJGastroenterol.2001Apr;96(4):1266-72.NarcoticanalgesiceffectsonthesphincterofOddi:areviewofthedataandtherapeuticimplicationsintreatingpancreatitis.ThompsonDR.DepartmentofInternalMedicine,BaylorUniversityMedicalCenter,Dallas,Texas75246,USA.AbstractOBJECTIVE:Traditionalteachingdictatesthatmorphineinduces"spasm"inthesphincterofOddi(SO)andshouldnotbeusedinacutepancreatitisandthatmeperidineistheanalgesicofchoicebecauseitdoesnotelevateSOpressures.Aliteraturesearchandreviewwasperformedtoevaluatethisteachingexaminingtheeffectofnarcoticanalgesic'seffectsonSO.METHODS:AMedlinesearchwasperformedusingkeywordsandphrases.Themanufacturersofmeperidinewerecontactedandtheirreportsandstudieswereobtainedandreviewed.RESULTS:Initialstudiesmeasuredbiliarypressureafternarcoticadministrationinanimals,andpostoperativeandintraoperativecholecystectomypatients.Allnarcoticsincreasedbiliarypressure,butmorphinewasassociatedwiththelargestelevation.LaterstudiesusingendoscopicretrogradecholangiopancreatographywithdirectSOmanometrydemonstratedthattheSOisexquisitelysensitivetoallnarcoticsincludingmeperidineandthatasmallincreaseinbiliarysphincterpressureisseenwithhigherdosesofmorphine.AllnarcoticsincreaseSOphasicwavefrequencyandinterferewithSOperistalsis.CONCLUSIONS:Narcotic-inducedincreasesinphasicwavefrequencyinterferewithSOfillingandareresponsiblefortheincreaseinbileductpressureseenontheinitialstudies.NostudiesdirectlycomparetheeffectsofmeperidineormorphineonSOmanometryandnocomparativestudiesexistinpatientswithacutepancreatitis.Nooutcome-basedstudiescomparingthesedrugshavebeenperformedinpatientswithacutepancreatitis.Morphinemaybeofmorebenefitthanmeperidinebyofferinglongerpainreliefwithlessriskofseizures.Nostudiesorevidenceexisttoindicatemorphineiscontraindicatedforuseinacutepancreatitis.第九页，共27页。結論1.Meperidine hastraditionallybeenfavoredovermorphine foranalgesiainpancreatitis,probablybecausehumanstudiesshowedthatmorphinecausedanincreaseinsphincterofOddipressure2.Despitethesedatathereisnoclinicalevidencetosuggestthatmorphinecanaggravateorcausepancreatitis.3.Repeateddosesofmeperidinecanleadtoaccumulationofthemetabolitenormeperidinethatcausesneuromuscularirritationand,rarely,seizures.Morphinemaybeofmorebenefitthanmeperidinebyofferinglongerpainreliefwithlessriskofseizures4.Intravenousmetamizoleshowsanon-significantassociationwithaquickerpainreliefthanmorphines.c.inacutepancreatitis.Alargerrandomizedcontrolledtrialshouldbedesirabletoconfirmthisresult.第十页，共27页。如何(rúhé)應用於臨床？2.使用(shǐyòng)Demerol需小心seizure的風險3.Metamizole也許是臨床上更好的選擇,仍需更多RCT第十一页，共27页。困境(kùnjìng)或陷阱目前仍無強力RCT證明何者(hézhě)為佳需要更多Trial第十二页，共27页。參考資料：證據的強度第十三页，共27页。參考資料：證據等級和臨床建議GradeofRecommendationLevelofEvidenceTherapy[A]1aSystemicreviewofRCTs1bSingleRCT1c‘All-or-none’[B]2aSystemicreviewofcohortstudies2bCohortstudyorpoorRCT2c‘Outcomes’research3aSystemicreviewofcase-controlstudies3bCase-controlstudy[C]4Caseseries[D]5Expertopinion,physiology,benchresearch第十四页，共27页。參考資料第十五页，共27页。實證醫學競賽－CAT摘要(zhāiyào)組別：第(A)組第十六页，共27页。訂定PICOP:acutepancreatitiswithabdominalpainI:gabexatemesilateC:placeboO:complication,mortality,morbidity,abdominalpain第十七页，共27页。資料庫來源PubmedCochraneUptodate第十八页，共27页。搜尋之關鍵字請列出你們用了哪些(nǎxiē)關鍵字。第十九页，共27页。搜尋之歷程請列出你們搜尋的歷程。第二十页，共27页。文獻研讀請列出你們認為證據最強的相關文獻一至三篇針對每篇文獻，請摘錄其：題目及出處(e.g.Dosingandsafetyofcyclosporineinpatientswithseverebraininjury.JNeurosurg.2008;109(4):699-707)研究(yánjiū)設計(studydesign)結果(若有計算NNT、RR、OR等，請一併列出)證據等級(levelofevidence)第二十一页，共27页。第一篇Prospectiveandrandomizedstudyofgabexatemesilateforthetreatmentofsevereacutepancreatitiswithorgandysfunction.(Hepatogastroenterology.2000Jul-Aug;47(34):1147-50)METHOD:52patientswithacutepancreatitisandorgandysfunctionwereenrolled.Thetreatmentgroupincluded26patientsreceivingintravenousgabexatemesilateinfusionatadoseof100mg/hrfor7days.APACHE-IIscore,clinicalandbiochemicalparametersweremonitoredintensively.CONCLUSION:Coagulopathyileus,andabdominalpainwassignificantlyimprovedwithgabexatemesilate.Gabexatemesilatereducedthenecessityforsurgicalinterventionandperitoneallavage.The7-day-mortalityand90-day-mortalityrateswerealsosignificantlyreducedwithgabexatemesilatetherapy.EVIDENCELEVEL:RCT,levelIb(gradeA)第二十二页，共27页。第二篇Clinicaltrialwithaproteaseinhibitorgabexatemesilateinacutepancreatitis.(IntJPancreatol.1991Summer;9:75-9)Retrospectiveanalysisof23patientswithsevereAPand88withmildtomoderateAPwhoweretreatedinourinstituteandfouraffiliatedmedicalcentersduringthe10-yperiodfrom1980to1990.Intravenousinfusionofaproteaseinhibitor,GabexateMesilate(FOY),wasstartedwithin24hfromonsetofAP(earlyadministration)in17patientswithsevereAPand51withmildtomoderateAP.TheremainingpatientswereputonFOYlaterthan24hfromonsetofAP(lateadministration).Comparisonofthemortalityandmorbiditybetweenthetwogroups,earlyvslateadministrationofFOY,ledtothefollowingconclusions:(1)EarlyadministrationofFOYsignificantlyimprovedmortality(29.4vs83.3%)insevereAP,althoughtheimprovementinmortalitywasnotdirectlyproportionaltotheshorteningofthetimelagbetweentheonsetofAPandthestartofFOY,and(2)earlieradministrationofFOYbroughtaboutsignificantlyearlierrecoveryofabdominalpain,hyperamylasemia,andleucocytosisinmildtomoderateAP.EVIDENCELEVEL:LEVELIIb(gradeB)第二十三页，共27页。結論與臨床應用UseofFOYforacutepancreatitisreducesmortalityandmorbidity,especiallyifusedearly.第二十四页，共27页。困境(kùnjìng)或陷阱Thesestudiesfocusonseverepancreatitisandlessonmildormoderate.第二十五页，共27页。謝謝聆聽第二十六页，共27页。内容(nèiróng) 总结 初级经济法重点总结下载党员个人总结TXt高中句型全总结.doc高中句型全总结.doc理论力学知识点总结pdf 實證醫學競賽－CAT摘要(zhāiyào)。109(4):699-707)。47(34):1147-50)第二十七页，共27页。