远程缺血调节与急性缺血中风的医疗管理或再输液治疗:系统性审查和元分析
Qi Li1, Jinxiu Guo1, Hui-Sheng Chen1
1From the Department of Neurology (Q.L., X.F., B.J., B.L., M.Y., Z.Q., Y.D.), The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou; Intensive Care Unit of Department of Neurology (J.G.), Ningbo Medical Center Lihuili Hospital; Department of Neurology (H.-S.C.), General Hospital of Northern Theater Command, Shenyang, China; Department of Neurology (R.A.B.), Aarhus University Hospital, Denmark; Department of Neurology (D.C.H.), Medical College of Georgia, Augusta University, Augusta; Neurology and Stroke Center (F.P.), Versailles Mignot Hospital, Paris, France; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Boston Medical Center (M.A., T.N.N.), Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (J.L.S.), University of California in Los Angeles; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Department of Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; and Department of Neurology (Q.Y.), Xinqiao Hospital of Army Medical University, Chongqing, China.
远程缺血调节 (RIC) 并没有改善中风患者的功能结果,但减少了中风复发,并改善了那些没有接受再输血治疗的人的NIHSS分数. 在接受IVT或MT的患者中,RIC没有显示任何益处.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 再生医学是一种再生医学.
背景情况:
- 远程缺血调节 (RIC) 是急性缺血中风的一种有希望的神经保护策略.
- 它的有效性和安全性仍然存在争议,需要对特定患者群体进行进一步的研究.
研究的目的:
- 对急性缺血性中风的RIC进行随机对照试验 (RCT) 进行系统审查和元分析.
- 评估RIC在不同治疗组 (医疗管理,IVT,MT) 的有效性和安全性.
主要方法:
- 搜索了主要的数据库 (PubMed,Embase,Cochrane等等) 在2023年5月之前.
- 包括22个RCT与7,657名患者.
- 主要结局:修改的兰金尺度 (mRS);次要结局:NIH中风量表 (NIHSS),中风复发;安全性:不良事件.
主要成果:
- 在任何治疗组中,RIC都没有改善mRS结果.
- 在医疗管理组中,RIC降低了中风复发率 (RR 0.63) 和NIHSS分数 (p < 0.00001).
- 在IVT或医疗管理组中,没有观察到RIC增加不良事件 (死亡,出血) 的风险.
结论:
- 在缺血性中风患者中,RIC对功能性结局 (mRS) 不有益.
- RIC显著改善NIHSS得分,并减少不符合再流疗法的患者中风复发.
- 在接受静脉输血栓溶解 (IVT) 或机械血栓切除 (MT) 的患者中,RIC没有观察到益处.
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