静脉注射和局部应用类固醇对颈椎前路手术后吞咽困难影响的Meta分析

Effects of intravenousinjection and topical steroids on dysphagia after anterior cervical surgery:a Meta analysis

目的系统评价静脉注射/局部应用类固醇对颈椎前路手术(anterior cervical spine surgery,ACSS)患者术后的吞咽困难影响,为临床提供循证参考。方法计算机检索万方、维普、CNKI、Pubmed、EMBASE、Cochrane library、Clinical Key和Wiley Online library等数据库,选择静脉注射/局部类固醇应用的颈椎前路手术文献进行研究,进行文献质量评价后采用Revman 5.3软件进行数据分析。结果共纳入7篇研究,静脉注射/局部应用类固醇激素组的吞咽困难发生率(OR=0.33,95%CI=0.21~0.51)、吞咽功能障碍DSQ评分(WMD=-0.92,95%CI=-1.28~-0.55)均显著低于对照组(P<0.01)。亚组分析显示,局部与静脉应用类固醇激素患者的术后吞咽困难发生率均显著低于对照组(P<0.01);静脉应用类固醇激素患者的脊柱融合率与对照组无显著差异(OR=0.93,95%CI=0.42~2.05,P=0.86)。结论静脉注射/局部应用类固醇可减少ACSS患者吞咽困难评分,降低吞咽困难发生率,对骨融合无不良影响。

Objective To systematically evaluate the effect of intravenous injection and local steroid on dysphagia after anterior cervical spine surgery(ACSS),so as to provide evidence-based reference for clinical practice.Methods The databases of WanFang,CQVIP,CNKI,PubMed,EMBASE,Cochrane Library,Clinical Key and Wiley Online Library were searched by computer for the study of anterior cervical surgery with intravenous injection/local steroid,and Revman 5.3 software was used for data analysis after literature quality evaluation.Results The incidence rate of dysphagia(OR=0.33,95%CI=0.21~0.51)and DSQ score(WMD=-0.92,95%CI=-1.28~-0.55)in intravenous injection/local steroid therapy group were lower than those in the control group(P<0.01).Subgroup analysis showed that the incidence rate of postoperative dysphagia in patients with local and intravenous steroid hormones was significantly lower than that in the control group(P<0.01).There was no significant difference in the spinal fusion rate between the two groups(OR=0.93,95%CI=0.42~2.05,P=0.86).Conclusion Intravenous injection/local steroid therapy can reduce the dysphagia score and the incidence rate of dysphagia in ACSS patients,but has no significant effect on bone fusion.