循证医学实践报告.docx

《循证医学实践报告.docx》由会员分享，可在线阅读，更多相关《循证医学实践报告.docx（5页珍藏版）》请在第一文库网上搜索。

1、循证医学实践报告老师，我在循证医学课上的随堂作业PICO的构建质量 差，刚好现在遇到一位难治性的妊娠剧吐患者，所以把任务 重做一遍！案例：患者高某，因“停经11+2周，恶心呕吐伴纳差 一周”入院，入院后予以补液维持水电解质平衡，维生素B6 及胃复安止吐等对症治疗一周后无明显好转，每日呕吐量达 IOoO+ml,患者及家属非常着急，询问是否有更有效的治疗 方案？比较异丙嗪与甲氧氯普胺治疗妊娠剧吐的疗效一、构建PlCO1、问题（P）：妊娠剧吐2、干预措施（I）：甲氧氯普胺3、对照措施（C）：异丙嗪4、结局指标（0）：呕吐缓解二、证据检索1、明确临床问题及问题类型疗效问题+治疗相关问题2、选择合适的数

2、据库：PUBMED、中国知网、超星图书、万 方数据库3、根据选择的数据库制定相应检索策略和关键词A、甲氧氯普胺异丙嗪妊娠剧吐Metoclopramide AND Promethazine4、评估检索结果：(部分)https：/PUbrned. ncbi. nl. nih. gov20410771https：/pubmed, ncbi. EllnL nih. gov/?term=%28%22Pronieth azine%22%5BMesh%5D%29+AND+%28%22Metoclopramide%22%5 BMeSh%5D%29&fiIter=PUbt. Tandoniizedcontrol

3、ledtrialNational Library of MedicineNMtoaeI Centar for Mecoogy Anxmafx(Prom5, dor W n3Mxr2$O64761V3PMIO 3921142 Fr PMC Mtkb. GmKAl TmUShareA National Library of Medicine y Atefione/Cenfer a xecotoyMxmah(yPUb 依Iedg5(aPrormthaimenMMhD AND (Metockpra Obstet Gyvwcol. 2010 MayJ 15(5)97S91 doc 10.1097/AOG

4、.0b013e3181d99290.Promethazine compared with metoclopramide for hyperemesis gravidarum: a randomized controlledAuthor Information (tftrfcs 8 Cwc(M09y it5. I (XMt 10.XWOGbO1)18kJW90F*vtxrtt.U MetrksP*tmsknAbstract In BriefOBJECTIVE:Tb compsr* lh effects of PrcXnehazn with tos Of nwtodopramtd。for hypr

5、emess gravSarmMETHODS:三、证据评价（一）初筛从PUBMED筛选 初筛以本文献为例：Promethazine compared with metoclopramide for hyperemesis gravidarum： a randomized controlled trialo异丙嗪与甲氧氯普胺治疗 妊娠剧吐的比较：一项随机对照试验。1、这篇文章是否来自同行评审的杂志?OBSTETRICSGYNECOLO(F 3T 1 5 CVVtWArticle* & Issues v CMEABOG MOC IlVtdooe v Journal Info v Authors vf

6、fl clf KllnA/orHitKxy 3ORMiMAl BfSCMCHPromethazine Compared With Metoclopramide for Hyperemesis GravidarumA Randomized Controlled TrialTan. Pvnf Ctuonf FRCOG; Khin. Pwim Phyu MB8S; VIUkUnfW. Narayaran MOG; OfnM Siti Zwih MOG5hr*Author informations/Obstetrks 8 6yntcofo0y 1l5(5kp Mey 2010.1 DOI: 10.WV

7、AOG.0b013e3181IW904edKJ MMf k它来自美国妇产科协会。2、这篇文章的研究场所是否与你的医院相似、以结果真实 应用到你的患者？这是在医院住院治疗的妊娠剧吐患者的研究。3、研究是否由某个组织所倡议？其研究设计或结果是否可 能因此受影响？与作者本人无利益冲突。4、如果文章提供的信息是真实的，对我的患者的健康有无 直接影响，是否为患者所关心的问题？与PlCO的“P” 一致，研究表明，妊娠剧吐的发生可能与地 区、经济、文化水平有关。5、是否为临床实践中常见的问题，文章中涉及的干预措施 或实验方法在我的医院是否可行？硫酸镁和异丙嗪在我院均有在用。6、文章提供的信息是真实的是否会改

8、变现有的医疗实践？我的这个患者甲氧氯普胺疗效差，是不是就可以换成异丙嗪 呢？(-)确定临床证据的类型这是一项随机对照试验(三)三性评价 真实性1是否将诊断性实验与金标准进行独立、盲法和同步比较。Methods: Women at their first hospitalization for hyperemesis gravidarum were approached when intravenous antiemetic therapy was needed. They were randomly assigned to receive 25 mg promethazine or 10 mg

9、 metoclopramide every 8 hours for 24 hours in a double-blind study. Primary outcomes were vomiting episodes by diary and well-being visual numerical rating scale score (10- point scale) in the 24-hour main study period. Participants also filled out an adverse-effects questionnaire at 24 hours and a

10、nausea visual numerical rating scale score at recruitment and at 8, 16, and 24 hours.真实性2研究对象选择是否包括适当的疾病谱。Methods: Women at their first hospitalization for hyperemesis gravidarum were approached when intravenous antiemetic therapy was needed. They were randomly assigned to receive 25 mg promethazine

11、 or 10 mg metoclopramide every 8 hours for 24 hours in a double-blind study. Primary outcomes were vomiting episodes by diary and well-being visual numerical rating scale score (10- point scale) in the 24-hour main study period. Participants also filled out an adverse-effects questionnaire at 24 hou

12、rs and a nausea visual numerical rating scale score at recruitment and at 8, 16, and 24 hours.真实性3诊断性实验的结果是否影响金标准的使用。Results: A total of 73 and 76 women, randomized to metoclopramide and promethazine, respectively, were analyzed. Median vomiting episodes were one (range 0-26) compared with two (range 0-26) (P=.81), and well-being visual numerical rating scale scores were 8 (range 1-10) compared with 7 (range 2-10) (P=.24) for metoclopramide and promethazine, respectively. Repeat-measures analysis of variance of the nausea visual numerical rating scale scores showed no signific