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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
过渡性缺血性发作和轻微中风的紧急治疗对早期复发性中风的影响 (EXPRESS研究):基于预期人口的顺序比较
Peter M Rothwell1, Matthew F Giles, Arvind Chandratheva
1Stroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK. peter.rothwell@clneuro.ox.ac.uk
Lancet (London, England)
|October 12, 2007
概括
过渡性缺血性心脏病发作 (TIA) 或轻微中风后的紧急治疗可以显著降低复发性中风的风险. 在临床环境中快速评估和启动预防疗法被证明是非常有效的.
科学领域:
- 神经学 神经学
- 血管医学 血管医学
- 公共卫生 公共卫生
背景情况:
- 在TIA或轻微中风后的一周内,高风险的复发性中风 (高达10%).
- 预防性治疗可以减少80-90%的风险,但由于缺乏证据,其利用率不足.
- 需要评估非直接入院的患者的快速治疗效果.
研究的目的:
- 确定加速评估和治疗对复发性中风风险的影响.
- 评估立即临床治疗与延迟初级保健启动之间的有效性.
- 分析TIA和轻微中风管理中的护理过程和患者结果.
主要方法:
- 在牛津血管研究 (OXVASC) 中的前后研究设计 (2002年4月 - 2007年3月).
- 对没有直接入院的TIA或轻微中风患者的结局进行比较.
- 主要结果:90天中风风险;次要:评估和治疗的延迟.
主要成果:
- 评估的中位延迟从3天减少到<1天;治疗的延迟从20天减少到1天 (p<0.0001).
- 在研究诊所中,90天的复发性中风风险从10.3%降至2.1% (aHR为0.20,p=0.0001).
- 风险降低在人口统计学上是一致的,并没有增加出血并发症.
结论:
- 在TIA/轻微中风后早期启动现有治疗,可实现80%的早期复发性中风风险降低.
- 调查结果支持立即改变服务提供和对TIA和轻微中风的公众宣传活动.
- 需要长期结果数据,但对医疗保健服务的直接影响是显著的.
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