【摘要】：目的：系統(tǒng)評(píng)價(jià)重組組織型纖溶酶原激活劑(rt-PA)治療急性缺血性腦卒中的療效及安全性。方法：檢索Cochrane圖書館(2013年第3期)、PubMed、EMbase數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)、中國(guó)學(xué)術(shù)期刊網(wǎng)全文數(shù)據(jù)庫(kù),收集rt-PA或安慰劑治療急性缺血性腦卒中的隨機(jī)或非隨機(jī)對(duì)照試驗(yàn),檢索時(shí)間為1995年1月-2013年6月。兩名評(píng)價(jià)者按照納入與排除標(biāo)準(zhǔn)選擇試驗(yàn)、提取資料和評(píng)價(jià)質(zhì)量后,采用RevMan5.0軟件進(jìn)行Meta分析。結(jié)果：納入7個(gè)隨機(jī)對(duì)照試驗(yàn)(RCT),共6548例患者。Meta分析結(jié)果顯示：rt-PA組治療急性缺血性腦卒中的3-6個(gè)月有利神經(jīng)評(píng)分[RR=1.22,95%CI(1.10,1.35),P=0.0002]高于安慰劑組；rt-PA在0-3h時(shí)間窗[RR=1.53,95%CI(1.32,1.78),P0.0001]、3-4.5h時(shí)間窗[RR=1.13,95%CI(1.02,1.25),P=0.02]有利神經(jīng)評(píng)分均優(yōu)于安慰劑組,4.5-6h時(shí)間窗rt-PA組較安慰劑組無(wú)統(tǒng)計(jì)學(xué)差異。rt-PA組的癥狀性顱內(nèi)出血發(fā)生率[RR=3.94,95%CI(2.31,6.70),P0.00001]高于安慰劑組,但兩組的3-6個(gè)月總體死亡率無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論：rt-PA組治療急性缺血性腦卒中較安慰劑組能獲得更好的有利神經(jīng)評(píng)分,在0-4.5h時(shí)間窗內(nèi)優(yōu)于安慰劑組,但在4.5-6h時(shí)間窗,兩組的有利神經(jīng)評(píng)分并無(wú)差別。rt-PA組較安慰劑組溶栓后癥狀性顱內(nèi)出血發(fā)生率更高,兩組的3-6個(gè)月總體死亡率無(wú)明顯差異。由于納入研究數(shù)量有限,.本研究結(jié)果尚需更多高質(zhì)量的隨機(jī)對(duì)照試驗(yàn)進(jìn)一步證實(shí)。
[Abstract]:Objective: to systematically evaluate the efficacy and safety of recombinant tissue type PA (rt-PA) in the treatment of acute ischemic stroke. Methods: the Cochrane Library (No. 3, 2013), the PubMed,EMbase Database, the Chinese Biomedical Literature Database and the full-text Database of the Chinese academic Journal Network were searched. Random or non-randomized controlled trials of rt-PA or placebo in the treatment of acute ischemic stroke were collected. The retrieval time was from January 1995 to June 2013. According to the inclusion and exclusion criteria, the two evaluators selected the test, extracted the data and evaluated the quality, and used RevMan5.0 software for Meta analysis. Results: a total of 6548 patients with (RCT), were included in 7 randomized controlled trials. Meta-analysis showed that the favorable nerve score [RR=1.22,95%CI (1.10, 1.35), P 鈮，

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