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1、第 組101101年度年度 實證醫學競賽報告實證醫學競賽報告第第 B B 組組8A 陳明怡 神經外科 劉恆維 NSICU侯俊宇第 組臨床場景一位剛剛發生顏面麻痺的病患,傳統上可以給予口服抗病毒藥物,以及類固醇,據說可以減少日後長久顏面神經麻痺與產生併發症機會,但病患對运用這兩種藥物有疑慮:1.我願意花錢買Acyclovir,但有效嗎?2.類固醇聽說對身體不好,可以勉強接受,但有效嗎?3.一定要兩個一同吃嗎?可以只吃Acyclovir嗎?第 組臨床問題PICO關鍵字關鍵字 (Keywords)P (patient)Bells palsyI (intervention)AcycolvirC (co
2、mparison)Acycolvir + prenisoloneO (outcomes)recovery問 題 類 型 ： 預後 診斷 傷害 預防第 組臨床問題PICO關鍵字關鍵字 (Keywords)P (patient)Bells palsyI (intervention)PrednisoloneC (comparison)PlaceboO (outcomes)recovery問 題 類 型 ： 預後 診斷 傷害 預防第 組搜尋歷程資料庫資料庫搜尋字串搜尋字串 / / 限制限制結果結果PubMed(Bells palsy) AND (acyclovir OR prednisolone) A
3、ND (recovery) engLA15Cochrane Bells palsy7第 組再次以文獻檢視PICO文獻標題文獻標題PICO關鍵字關鍵字比對結果比對結果P (patient)符合符合I (intervention)符合符合C (comparison)符合符合O (outcomes)符合符合第 組再次以文獻檢視PICO文獻標題文獻標題PICO關鍵字關鍵字比對結果比對結果P (patient)符合符合I (intervention)符合符合C (comparison)符合符合O (outcomes)符合符合第 組再次以文獻檢視PICO文獻標題文獻標題PICO關鍵字關鍵字比對結果比對結果
4、P (patient)符合符合I (intervention)符合符合C (comparison)符合符合O (outcomes)符合符合第 組文獻評讀第 組Corticosteroid and antiviral therapy for Bells palsy: A network meta-analysisBMC Neurology 2021, 11:1 Pawin Numthavaj, Ammarin Thakkinstian, Charungthai Dejthevaporn, John Attia Meta-analysis, Medline and EMBASE, RCT (1a)
5、 Six studies (total n = 1805) Resolution at 3 months: ORs of Prdnisolone + antivirals v.s prednisolone + placebo: 1.24 Prednisolone-based treatment v.s non-Prednisolone-based treatment 2-fold chance of recovery (95% CI: 155 - 242)Prdnisolone + antivirals may lead to slightly higher recovery rates co
6、mpared to treating with prednisone alone does not quite reach statistical significance第 組Antiviral treatment for Bells palsy (idiopathic facial paralysis) The cochrane library Published Online: 16 JUN 2021Pauline Lockhart1, Fergus Daly, Marie Pitkethly, Natalia Comerford, Frank Sullivan1 Meta-analys
7、isRCT of antivirals with and without corticosteroids versus control therapies for the treatment of Bells palsy.23 papers(n=1987)Incomplete recovery at one year:Antivirals v.s placebo:No significant benefit in the rate of incomplete recovery(n = 1886, RR 0.88, 95% CI 0.65 to 1.18)Antivirals v.s corti
8、costeroidsthe outcome with antivirals was significantly worse(n = 768, RR 2.82, 95% CI 1.09 to 7.32) Antivirals + corticosteroids v.s antivirals + placeboThe outcome was significantly better(n = 658, RR 0.56, 95% CI 0.41 to 0.76)第 組Corticosteroids for Bells palsy (idiopathic facial paralysis) The co
9、chrane library Published Online: 17 MAR16 JUN 2021 Rodrigo A Salinas1, Gonzalo Alvarez, Fergus Daly, Joaquim FerreiraCochrane Neuromuscular Disease Group Trials Specialized Register, MEDLINE, EMBASE, LILACS7 trials(n=1507)incomplete recovery of facial motor function six months or moreCorticosteroid
10、v.s placebosignificantly less than 245/753 (33%) (RR) 0.71, 95% CI 0.61 to 0.83) a significant reduction in motor synkinesis during follow-up in those receiving corticosteroids (RR 0.6, 95% CI 0.44 to 0.81). The reduction in the proportion of patients with cosmetically disabling sequelae six months
11、after randomisation, however, was not significant (RR 0.97, 95% CI 0.44 to 2.15). 第 組A randomised controlled trial of the use of aciclovir and/or prednisolone for the early treatment of Bells palsy: the BELLS study.Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, Davenport RJ, Va
12、le LD, Clarkson JE, Hernndez R, Stewart K, Hammersley V, Hayavi S, McAteer A, Gray D, Daly F.SourceScottish School of Primary Care, University of Dundee, UK.randomised double-blind trial(n=496)There were significant differences in complete recovery at 3 months between the prednisolone comparison gro
13、upsNine-month assessments of patients recovered were 94.4% for prednisolone compared with 81.6% for no prednisolone, a difference of + 12.8% (95% CI: + 7.2% to + 18.4%, p 0.001)The increase in recovery rate conferred by the addition of prednisolone (both for prednisolone over placebo and for aciclov
14、ir-prednisolone over aciclovir) is highly statistically significant (p 0.001).At 3 months the recovery rate was 86.3% in the prednisolone treatment group, 79.7% in the aciclovir-prednisolone group, 64.7% in the placebo group and 62.5% in the aciclovir group. At 9 months the recovery rates were respe
15、ctively 96.1%, 92.7%, 85.3% and 78.1%.This study provided robust evidence to support the early use of oral prednisolone in Bells palsy as an effective treatment which may be considered cost-effective. Treatment with aciclovir, either alone or with steroids, had no effect on outcome.第 組結論Steroid目前仍是主要之治療, 有明顯之效果Acyclovir單純运用並沒有明顯之療效合併运用可改善預後第 組Thank you for your attention
