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1、科別:口腔正畸科住院號:38871初診日期：2013年1月報告者姓名：職務(wù)：□住院醫(yī)師□基地醫(yī)師13實習(xí)醫(yī)師完成時間:2014.4.12病例摘要黃某，男，21歲。初診日期：2013年1刀；結(jié)束時間：2014年4刀。主訴：夜間睡眠打鼾憋氣5年。診斷：骨性11類，牙性11類，輕度睡眠呼吸暫停綜合征矯治設(shè)計：正畸治療，1ST矯治器初期：效果不佳，改用TAP矯治器效果：1.睡眠呼吸暫停癥狀徹底解除。2.上下頜牙齒排齊整平，前牙覆牙合、覆蓋正常，中線對齊，磨牙、尖牙關(guān)系中性，側(cè)貌有所改善。提出可回答的臨床問題(Asking)P:輕中度OSAHS患
2、者I：TAP矯治器C:1ST矯治器O：治療效果提高檢索最有用的證據(jù)(Acquire)關(guān)鍵詞(Keyword)：OSAHS,oralappliances數(shù)據(jù)庫來源(Database)：PubMcdClinicalQueries主要內(nèi)容：Arandomizedprospectivelong-termstudyoftwooralappliancesforsleepapnoeatreatmentSUMMARYVarioustypesofmandibularprotrusiveapplianceshaverevealeddifferenttrea
3、tmentsuccessinmild-to-moderateobstructivesleepapnoea(OSA).Thepresentstudycomparedthelong-termeffectoftwodifferentappliancesinthetreatmentofOSA?Atotalof103patientswithOSAwererandomizedandtreatedwithanISTorThorntonAnteriorPositioner(TAP)appliance?Theywerefollowed-upafteras
4、hort-termtreatmentperiodof6monthsandlong-termtreatmentperiodofover24months.Sleepstudiesinthesleeplaboratorywereconductedwithandwithouttheappliances,andvariousquestionnairesassessingsubjectivedaytimesleepiness,sleepquality,qualityoflifeandsymptomscoreswereadministeredatea
5、chtimeinterval.Qualityoflife,sleepquality,sleepiness,symptomsandsleepoutcomeshowedsignificantimprovementintheshort-termevaluationwithbothappliances,buttheTAPappliancerevealedasignificantlygreatereffect.Aftermorethan2yearsoftreatment,sleepoutcomesrevealedanequaleffectwith
6、bothappliances?Thesubjectivebenefitsachievedinitiallylessenedsignificantly.ThisstudyillustratesthatboththeISTandtheTAPappliancesareeffectivetherapeuticdevicesforOSAafteraperiodofover24months.Lackofcompliancemaybeduetoinsufficientimprovementinanticipatedsubjectivesymptoms
7、and/orarecurrenceofsymptomsovertime.證據(jù)評價(Appraisal)證據(jù)等級：A級Worksheet:一、真實性隨機分組①，隱藏措施(計算機隨機)②，基線一致③，short-term時間短，失訪率低，long-termT2隨訪時間長，失訪率高④，無具休指岀而是引用其他文獻(xiàn)方法，可推測ITT⑤，采用盲法，測量指標(biāo)客觀⑥，基礎(chǔ)治療一致⑦二、強度與精度：1.short-term:P<0.05,P<0.001comparedwithouttheappliance,P<0.051STapplianceversus
8、TAPappliance.1STappliance:n=47;TAPappliances:n=48.Valuesaremeans±SD,medians(quartilesranges)?2.long-ter
