不同類固醇注射介入腕隧道症候群病人之成效－－貝氏網絡統合分析

The Effectiveness of Different Corticosteroid Injections in Patients With Carpal Tunnel Syndrome: A Bayesian Network Meta-AnalysisA Systematic Review of the Literature Related to Elevating the Head of the Bed for Patients With Gastroesophageal Reflux Disease: Applications in Patients After Esophageal Cancer Surgery

背景：類固醇注射是緩解腕隧道症候群之介入措施之一，綜觀國內外的研究，並沒有針對類固醇注射緩解腕隧道症候群成效分析一致性的結果。目的：本統合分析在了解不同的局部注射類固醇策略，於改善腕隧道症候群病人嚴重程度和功能之成效。方法　採系統性回顧法，關鍵字為：腕隧道症候群（carpal tunnel syndrome）、類固醇（corticosteroid*）[Title/ Abstract]、安慰劑（placebo）、失能（disability）、疼痛強度（pain intensity），搜尋Cochrane Library、CINAHL（Cumulative Index to Nursing and Allied Health Literature）、ProQuest、PubMed各資料庫，截至2015年6月符合納入準則進行文獻搜尋。研究品質以＂Cochrane Handbook for Systematic Reviews of Intervention＂ to assess the risk of bias tool做評讀，使用WinBUGS統計軟體進行統合分析。結果　評讀後納入10篇品質良好的研究，共633位個案。接受超音波導引平行類固醇注射病人的嚴重程度量表（symptom severity scale）median MD為-1.16（95%CrI [-1.95, .38]），SUCRA（surface under the cumulative ranking curve曲線下表面累計排名）達95%，病人的功能程度量表（functional status scale）median MD為-.74（95%CrI [-2.0, .52]，SUCRA達78%，三種注射法與安慰劑相比較，超音波導引平行類固醇注射法改善嚴重程度及功能程度成效最優。結論　類固醇注射有助於減輕腕隧道症候群病人的症狀嚴重度及提升功能程度，其中超音波導引平行類固醇注射成效更高，本網絡統合分析可提供復健護理之參考。

Background: Corticosteroid injection is one of the interventions used to alleviate the symptoms of carpal tunnel syndrome. The consistency across domestic and overseas studies of the results of corticosteroid injections in terms of easing carpal tunnel syndrome has not previously been analyzed. Purpose: This meta-analysis explored the symptom severity and functional status of different corticosteroid injection strategies in treating patients with carpal tunnel syndrome. Methods: A systematic review was performed, keywords including: carpal tunnel syndrome, corticosteroid*[Title/ Abstract], placebo, disability, and pain intensity were used to query electronic databases, including Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ProQuest, PubMed database. All of the articles that were indexed on these databases, met the inclusion criteria, and were published prior to June 2015 were extracted for analysis. A standardized critical appraisal tool from the ＂Cochrane Handbook Systematic Reviews of Intervention＂ to assess the risk of bias tool was used to assess methodological quality. WinBUGS software was used to conduct the meta-analysis. Results: The 10 articles that were qualified and used in the present study contained a total of 633 participants. Median symptom severity was -1.16 (95%CrI [-1.95, .38]) on the symptom severity scale for ultrasound-guided in-plane injection among patients with carpal tunnel syndrome. The surface under the cumulative ranking curve (SUCRA) achieved 95%. The median MD was -.74 (95%CrI [-2.0, .52]) on the functional status scale for ultrasound-guided inplane injection among patients with carpal tunnel syndrome. The (SUCRA) achieved 78%. The results indicate that the three injection methods reduced the severity and improved the functional status in comparison with the placebo, ultrasound- guided in-plane corticosteroid injection. Conclusions: Corticosteroid injections alleviate symptom severity and promote functional status in patients with carpal tunnel syndrome. Ultrasound-guided in-plane injections demonstrated greater effectiveness. The network meta- analysis provides a reference for rehabilitation nursing.