動(dòng)靜脈聯(lián)合溶栓治療急性腦梗死的臨床獲益及安全性的meta分析
發(fā)布時(shí)間：2018-12-21 18:08
【摘要】：背景:急性腦梗死帶來(lái)的高致死、致殘率已成為困擾無(wú)數(shù)腦卒中病人及家屬的噩夢(mèng),當(dāng)前最有效的恢復(fù)腦梗塞缺血區(qū)再灌注的方法之一就是溶栓治療,而目前溶栓的方法主要以靜脈溶栓和動(dòng)脈溶栓為主,關(guān)于動(dòng)靜脈聯(lián)合溶栓國(guó)內(nèi)外也有部分相關(guān)的報(bào)道。目的:本文旨在對(duì)動(dòng)靜脈聯(lián)合溶栓治療急性缺腦梗塞的臨床獲益及安全程度進(jìn)行評(píng)估。方法:分別以intravenous thrombolysis,intra-arterial thrombolysis,IA,IV,IA+IV,acute cerebral infarction,acute ischemic stroke,combined,randomized controlled trials等英文詞組合檢索Pubmed、Cochrane Central Register of Controlled Trials、Embase Database、CNKI、維普數(shù)據(jù)庫(kù)、萬(wàn)方全文數(shù)據(jù)庫(kù),收集1999-2016年前的動(dòng)靜脈溶栓治療急性腦梗死的隨機(jī)對(duì)照試驗(yàn)RCT,根據(jù)既定的納入和排除標(biāo)準(zhǔn)進(jìn)行試驗(yàn)選擇、資料提取、文獻(xiàn)質(zhì)量評(píng)估和證據(jù)可靠度檢驗(yàn)。應(yīng)用RevMan5.3軟件對(duì)收集到的數(shù)據(jù)進(jìn)行meta分析。結(jié)果:納入1999-2016年間的中英文文獻(xiàn)共9篇,總共516例病例,其中動(dòng)靜脈聯(lián)合溶栓組為240例,行單一溶栓途徑(IV/IA)276例。動(dòng)靜脈聯(lián)合溶栓治療急性腦梗死相較于單純動(dòng)脈或單純靜脈溶栓,其24h、3月后神經(jīng)功能改善狀況及血管再通率均有優(yōu)勢(shì);而癥狀性腦出血及3-6月死亡率較單純動(dòng)脈或靜脈溶栓無(wú)明顯增加。動(dòng)靜脈聯(lián)合溶栓治療急性腦梗死的療效及安全性均在可接受范圍內(nèi)。(1)聯(lián)合溶栓組神經(jīng)功能預(yù)后改善情況有效率高于單一途徑溶栓組:聯(lián)合溶栓組溶栓24h后的NIHSS評(píng)分改善情況優(yōu)于對(duì)照組(OR=2.34,95%CI1.57-3.48,P0.01),聯(lián)合溶栓組溶栓后3月的mRs評(píng)分(0-2)改善優(yōu)于對(duì)照組(OR=1.79,95%CI 1.14-2.82,P=0.01);(2)動(dòng)靜脈聯(lián)合溶栓的血管再通率高于其他溶栓方法(OR=2.35,95%CI 1.52-3.62,P0.01);(3)聯(lián)合溶栓組的安全性與對(duì)照組相比并沒(méi)有顯著的差異:兩組溶栓后繼發(fā)癥狀性腦出血的風(fēng)險(xiǎn)無(wú)明顯差異(OR=0.59,95%0.33-1.07,P=0.08);兩組溶栓后死亡風(fēng)險(xiǎn)無(wú)顯著差異(OR=0.84,95%0.43-1.65,P=0.61)。結(jié)論:動(dòng)靜脈聯(lián)合溶栓治療急性腦梗塞相較于動(dòng)脈或靜脈溶栓,其溶栓后24h神經(jīng)功能改善狀況和3月短期神經(jīng)功能預(yù)后及血管再通率均有提高;而癥狀性腦出血及3-6月死亡率較單純動(dòng)脈或靜脈溶栓無(wú)明顯增加。動(dòng)靜脈聯(lián)合溶栓治療急性缺血性腦卒中的臨床獲益以及安全程度均在可接受范圍內(nèi)
[Abstract]:Background: the high mortality and disability rate caused by acute cerebral infarction has become a nightmare for numerous stroke patients and their families. Thrombolytic therapy is one of the most effective methods to restore reperfusion in ischemic areas of cerebral infarction. At present, the main methods of thrombolysis are intravenous thrombolysis and arterial thrombolysis. Objective: to evaluate the clinical benefit and safety of combined arteriovenous thrombolysis in the treatment of acute cerebral infarction. Methods: Pubmed,Cochrane Central Register of Controlled Trials,Embase Database,CNKI, Weip database and Wanfang full-text database were retrieved by intravenous thrombolysis,intra-arterial thrombolysis,IA,IV,IA IV,acute cerebral infarction,acute ischemic stroke,combined,randomized controlled trials and other English word combinations, respectively. A randomized controlled trial (RCT,) of arteriovenous thrombolytic therapy for acute cerebral infarction (ACI) from 1999 to 2016 was collected for trial selection, data extraction, literature quality assessment and evidence reliability test according to established inclusion and exclusion criteria. The data collected are analyzed by meta using RevMan5.3 software. Results: there were 9 articles in Chinese and English from 1999 to 2016. A total of 516 cases were included, including 240 cases in arteriovenous thrombolysis group and 276 cases in single thrombolytic pathway (IV/IA). Compared with simple arterial or venous thrombolytic therapy combined with arteriovenous thrombolytic therapy, the improvement of nerve function and the rate of recanalization of blood vessels in 24 h and 3 months after thrombolytic therapy were superior to those of simple arterial or venous thrombolytic therapy. Symptomatic intracerebral hemorrhage and 3-6 months mortality were not significantly increased compared with arterial or venous thrombolysis alone. The efficacy and safety of combined arteriovenous thrombolysis in the treatment of acute cerebral infarction were within acceptable range. (1) the effective rate of nerve function improvement in combined thrombolytic group was higher than that in single thrombolytic group: 24 hours after thrombolytic therapy in combined thrombolytic group The improvement of NIHSS score in control group was better than that in control group (OR=2.34,95%CI1.57-3.48,). The mRs score (0-2) in the combined thrombolytic group was better than that in the control group (OR=1.79,95%CI 1.14-2.82 P0.01). (2) the recanalization rate of arteriovenous thrombolysis was higher than that of other thrombolytic methods (OR=2.35,95%CI 1.52-3.62P0.01). (3) the safety of the combined thrombolytic group was not significantly different from that of the control group: there was no significant difference in the risk of secondary symptomatic intracerebral hemorrhage (OR=0.59,95%0.33-1.07,P=0.08) between the two groups; There was no significant difference in the risk of death after thrombolysis (OR=0.84,95%0.43-1.65,P=0.61) between the two groups. Conclusion: compared with arterial or venous thrombolytic therapy combined with arteriovenous thrombolytic therapy, the improvement of nerve function at 24 hours after thrombolytic therapy, the prognosis of short-term nerve function in 3 months and the recanalization rate of blood vessels were improved. Symptomatic intracerebral hemorrhage and 3-6 months mortality were not significantly increased compared with arterial or venous thrombolysis alone. Clinical benefits and safety of combined arteriovenous thrombolysis in the treatment of acute ischemic stroke are within acceptable limits
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R743.33
本文編號(hào)：2389270
[Abstract]:Background: the high mortality and disability rate caused by acute cerebral infarction has become a nightmare for numerous stroke patients and their families. Thrombolytic therapy is one of the most effective methods to restore reperfusion in ischemic areas of cerebral infarction. At present, the main methods of thrombolysis are intravenous thrombolysis and arterial thrombolysis. Objective: to evaluate the clinical benefit and safety of combined arteriovenous thrombolysis in the treatment of acute cerebral infarction. Methods: Pubmed,Cochrane Central Register of Controlled Trials,Embase Database,CNKI, Weip database and Wanfang full-text database were retrieved by intravenous thrombolysis,intra-arterial thrombolysis,IA,IV,IA IV,acute cerebral infarction,acute ischemic stroke,combined,randomized controlled trials and other English word combinations, respectively. A randomized controlled trial (RCT,) of arteriovenous thrombolytic therapy for acute cerebral infarction (ACI) from 1999 to 2016 was collected for trial selection, data extraction, literature quality assessment and evidence reliability test according to established inclusion and exclusion criteria. The data collected are analyzed by meta using RevMan5.3 software. Results: there were 9 articles in Chinese and English from 1999 to 2016. A total of 516 cases were included, including 240 cases in arteriovenous thrombolysis group and 276 cases in single thrombolytic pathway (IV/IA). Compared with simple arterial or venous thrombolytic therapy combined with arteriovenous thrombolytic therapy, the improvement of nerve function and the rate of recanalization of blood vessels in 24 h and 3 months after thrombolytic therapy were superior to those of simple arterial or venous thrombolytic therapy. Symptomatic intracerebral hemorrhage and 3-6 months mortality were not significantly increased compared with arterial or venous thrombolysis alone. The efficacy and safety of combined arteriovenous thrombolysis in the treatment of acute cerebral infarction were within acceptable range. (1) the effective rate of nerve function improvement in combined thrombolytic group was higher than that in single thrombolytic group: 24 hours after thrombolytic therapy in combined thrombolytic group The improvement of NIHSS score in control group was better than that in control group (OR=2.34,95%CI1.57-3.48,). The mRs score (0-2) in the combined thrombolytic group was better than that in the control group (OR=1.79,95%CI 1.14-2.82 P0.01). (2) the recanalization rate of arteriovenous thrombolysis was higher than that of other thrombolytic methods (OR=2.35,95%CI 1.52-3.62P0.01). (3) the safety of the combined thrombolytic group was not significantly different from that of the control group: there was no significant difference in the risk of secondary symptomatic intracerebral hemorrhage (OR=0.59,95%0.33-1.07,P=0.08) between the two groups; There was no significant difference in the risk of death after thrombolysis (OR=0.84,95%0.43-1.65,P=0.61) between the two groups. Conclusion: compared with arterial or venous thrombolytic therapy combined with arteriovenous thrombolytic therapy, the improvement of nerve function at 24 hours after thrombolytic therapy, the prognosis of short-term nerve function in 3 months and the recanalization rate of blood vessels were improved. Symptomatic intracerebral hemorrhage and 3-6 months mortality were not significantly increased compared with arterial or venous thrombolysis alone. Clinical benefits and safety of combined arteriovenous thrombolysis in the treatment of acute ischemic stroke are within acceptable limits
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R743.33
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