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[通过麻醉学和疼痛医学的实例解释荟萃分析]

[Meta-analyses-Explained my means of examples from anesthesia and pain medicine].

作者信息

Bäumler Petra, Irnich Dominik

机构信息

Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, LMU Klinikum, LMU München, Pettenkoferstr 8a, 80336, München, Deutschland.

出版信息

Anaesthesiologie. 2024 Oct;73(10):647-655. doi: 10.1007/s00101-024-01460-y. Epub 2024 Sep 23.

Abstract

Meta-analyses are a central part of systematic reviews. The term meta-analysis describes the statistical methods to summarize the results of the available scientific studies providing the highest possible evidence. In medicine, meta-analyses aim to guide clinical decisions. This article provides an overview of the necessary work steps.The classical meta-analysis summarizes the results of randomized controlled trials that compare an intervention against a control intervention. This is illustrated by means of an example from a Cochrane Review on videolaryngoscopy in comparison to direct laryngoscopy. Crucial methodological aspects such as the weighting of individual studies when pooling their results as well as the evaluation of study heterogeneity and potential publication bias are explained.The second part of the article focusses on two extensions of meta-analyses: the individual patient data meta-analysis and the network meta-analysis. The individual patient data meta-analysis makes use of the information that is available from the patient-level data of the included studies. As an example, the work accomplished by an international collaboration on the efficacy of acupuncture in chronic pain is presented. A network meta-analysis enables the comparison of more than two interventions by making use not only of the available direct but also of the respective indirect evidence. This is illustrated by means of a Cochrane Review on drugs for the prophylaxis of postoperative nausea and vomiting.

摘要

Meta分析是系统评价的核心部分。Meta分析这一术语描述了用于总结现有科学研究结果的统计方法,这些研究提供了尽可能高的证据。在医学领域,Meta分析旨在指导临床决策。本文概述了必要的工作步骤。经典的Meta分析总结了比较一种干预措施与对照干预措施的随机对照试验的结果。这通过Cochrane系统评价中关于视频喉镜检查与直接喉镜检查比较的一个例子来说明。文中解释了一些关键的方法学方面,如合并各个研究结果时对单个研究的加权,以及对研究异质性和潜在发表偏倚的评估。本文的第二部分重点介绍了Meta分析的两种扩展:个体患者数据Meta分析和网状Meta分析。个体患者数据Meta分析利用纳入研究中患者层面数据可得的信息。例如,展示了一项关于针灸治疗慢性疼痛疗效的国际合作所完成的工作。网状Meta分析不仅利用现有的直接证据,还利用各自的间接证据,从而能够比较两种以上的干预措施。这通过Cochrane系统评价中关于预防术后恶心和呕吐药物的例子来说明。

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