临床儿科杂志 ›› 2014, Vol. 32 ›› Issue (7): 686-.doi: 10.3969 j.issn.1000-3606.2014.07.022

• 循证医学 • 上一篇    下一篇

儿童吉兰- 巴雷综合征临床指南的系统评价及循证用药

张宏亮1,廖乙媚2,刘滔滔1   

  1. 1. 广西医科大学第一附属医院药学部( 广西南宁 530021);2. 广西医科大学药学院( 广西南宁 530021)
  • 收稿日期:2014-07-15 出版日期:2014-07-15 发布日期:2014-07-15
  • 通讯作者: 刘滔滔 E-mail:58549652@qq.com

Systematic review of clinical guidelines for Guillain-Barré syndrome in children

ZHANG Hongliang1, LIAO Yimei2, LIU Taotao1   

  1. 1.The Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University; 2.College of Pharmaceutical Science of Guangxi Medical University, Nanning, 530021, Guangxi, China
  • Received:2014-07-15 Online:2014-07-15 Published:2014-07-15

摘要: 目的 系统评价儿童吉兰- 巴雷综合征(GBS)的相关指南,为临床循证用药提供一定的参考。方法 计算机检索PubMed、EMbase、CBM、万方数据、中国知网、维普网等中英文数据库中GBS 相关指南;其次检索美国医疗保健与质量局(NGC)、国际指南数据库(GIN)、Trip 等指南数据库以及各大医学会及行业机构网站包括美国疾病预防控制中心(CDC)、美国感染病学会(IDSA)、美国儿科学会(AAP)、世界卫生组织(WHO)、中国卫生和计划生育委员会网站、中国临床指南文库和中国临床指南协作网。检索时限均为从建库或建网至2013 年10 月。由2 位研究者按照纳入与排除标准独立筛选文献,并采用AGREE Ⅱ工具评价指南的质量,使用组内相关系数(ICC) 进行评价员间一致性检验。结果 最终纳入指南5 篇,时间跨度从2003—2012 年,5 篇指南分别来自美国、欧洲和加拿大。纳入指南最终推荐均为B级,在AGREE Ⅱ各领域中“制定严谨性”与“清晰性”总体得分最高,而得分普遍较低的领域是“应用性”。血浆置换(PE)和静滴丙种球蛋白(IVIG) 对于GBS 的治疗均可获得较好的效果,但不建议两者联合应用,同时对于激素的使用也持否定的态度。结论 儿童GBS 治疗的选择,各指南推荐内容基本一致。循证指南中对证据级别和推荐强度的划分标准不一,有待进一步完善,同时指南地应用策略要进一步加强。

Abstract: Objective To systematic review the methodological quality of guidelines for Guillain-Barré syndrome (GBS) in children, to provide a reference for clinical evidence-based medicine. Methods Guidelines concerning GBS were electronically retrieved from PubMed, EMbase, CBM, Wanfang data, CNKI and Vip. The guide databases includes major medical institutions and industry sites such as NGC, GIN, TRIP , CDC, IDSA, AAP, WHO, Chinese Health and Family Planning Committee website, library of clinical guidelines China and Chinese clinical guidelines for collaboration. All the data were searched from inception of the database or network to Oct. 2013. Two reviews independently screened literature according to the inclusion and exclusion criteria, and assessed the quality of guideline using the AGREEⅡ . Intraclass correlation coefficient (ICC) was used to examine the conformance of the raters' evaluation scores. Results A total of 5 guidelines concerning GBS were included, with a time range from 2003 to 2012, and origins from USA, EU and Canada. The final recommendation levels of the 5 articles were level B. According to the AGREEⅡ, domain 3 and 4 showed the higher scores, and scores were generally low in domain 5. Plasma exchange (PE) and intravenous immuneglobulin (IVIG) showed positive effects on the treatment of GBS. But it was not recommended that combined PE and IVIG. Corticosteroids are also not recommended for GBS treatment. Conclusions The recommendations of medicines for GBS are basically consistent. However, the classification criteria of the levels of evidence and recommendation are still unconsistent and suboptimal. The guidelines on GBS should be improved in “Applicability” in future.