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在急性缺血性中风患者中进行静脉内血栓溶解,具有前中风残疾:系统性审查和元分析
Qiangji Bao1, Xinting Wu2, Yiming Li3
1Department of Neurosurgery, Guang'an People's Hospital, Guang'an, Sichuan, China.
Brain and behavior
|February 16, 2024
概括
对于急性缺血性中风 (AIS) 的静脉输血栓溶解 (IVT) 与中风前残疾 (PSD) 患者的死亡率较高有关. 然而,IVT对这个群体的症状性脑内出血或24小时NIHSS改善没有显著差异.
科学领域:
- 神经学 神经学
- 脑卒中医学 脑卒中医学
- 公共卫生 公共卫生
背景情况:
- 内静脉血栓溶解 (IVT) 是急性缺血性中风 (AIS) 的标准一线治疗方法.
- 在AIS患者中IVT的有效性和安全性仍然存在争议.
- 了解PSD对IVT结果的影响对于治疗个性化至关重要.
研究的目的:
- 确定中风前残疾 (PSD) 与急性缺血性中风 (AIS) 患者静脉血栓溶解 (IVT) 的安全性和疗效之间的关联.
- 分析PSD对死亡率,功能结果和AISIVT后并发症的影响.
主要方法:
- 在PubMed,Embase和Cochrane图书馆进行了系统的文献搜索,截至2022年5月23日.
- 使用随机效应模型对10项涉及245,773名参与者的研究数据进行了元分析.
- 评估的结果包括死亡率,24小时NIHSS改善,症状性脑内出血 (sICH) 和良好的功能结果 (FFO).
主要成果:
- 在接受IVT的AIS患者中,中风前残疾 (PSD) 与增加的死亡率 (ORadj 1.789) 和更高的良好功能结果 (FFO) (ORadj 1.087) 的可能性 (ORadj 1.087) 相联系.
- 在患有和没有PSD的患者之间,在症状性脑内出血 (sICH) (ORadj 0.857) 或24小时NIHSS改善率 (ORadj 0.837) 中没有发现显著差异.
- 在患有PSD的患者中 (mRS 2-5),FFO的患病率为49%,死亡率为37%.
结论:
- 患有中风前残疾 (PSD) 的患者接受IVT治疗急性缺血性中风 (AIS),与没有PSD的患者相比,死亡率更高.
- PSD与有利的功能结果有关,但在症状性脑内出血或早期神经改善方面没有显著差异.
- 需要进一步进行高质量的研究,以充分阐明IVT在AIS患者中具有前中风残疾的好处.
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