脑卒中临床实践指南推荐意见的系统评价

Systematic review on recommendations of clinical practice guidelines for stroke

目的目前脑卒中临床实践指南的推荐意见质量参差不齐,采用AGREE-REX评价指南推荐意见的质量。方法检索PubMed、CBM、WanFang Data、CNKI等数据库及医脉通、WHO、NICE、WSO、GIN、SIGN等指南网站,手动检索网上书店,检索2019年1月1日至2020年12月31日发表的脑卒中临床实践指南,采用AGREE-REX评价推荐意见的质量,并对治疗的推荐意见进行定性分析。结果最终纳入14篇指南,在AGREE-REX的3个领域,即临床适用性、价值观和偏好、可实施性的平均得分率分别为44.84%、13.99%、30.95%,结合各指南的推荐意见,脑卒中急性期治疗及并发症处理方面的推荐清晰明确。但机械取栓、直接取栓、醒后卒中及神经保护治疗等最新证据相关的推荐意见有待写入指南。结论脑卒中临床实践指南的推荐意见适用性较好,即能解决大部分的临床关键问题。但是,部分新证据有待写入指南,且指南实施相关要素如患者价值观与地区适用性有待加强。

Objective To review the quality of recommendations of clinical practice guidelines for stroke by using AGREE-REX because of the quality is various.Methods The databases of PubMed,CBM,WanFang Data and CNKI,and guideline websites including Medlive,WHO,NICE,WSO,GIN and SIGN were retrieved,and online bookstores were retrieved manually for searching clinical practice guidelines for stroke published from Jan.1,2019 to Dec.31,2020.The quality of recommendations of clinical practice guidelines for stroke was reviewed by using AGREE-REX,and the recommendations were given a quality analysis.Results There were finally 14 guidelines included.In 3 fields of AGREE-REX,the average scoring rate was 44.84%in clinical applicability,13.99%in sense of values and preference and 30.95%in implementability.It was clear and precise for the recommendations about the treatment of acute stroke and complications.The recommendations related the newest evidences of mechanical thrombectomy,direct thrombectomy,wake-up stroke and neuroprotective therapies were suggested to be written into guidelines.Conclusion The recommendations of clinical practice guidelines for stroke have higher applicability and can answering the questions essential to clinical practice.But some new evidences are suggested to be written into guidelines,and elements related to guideline implementation,including patients’values and regional applicability,need to development.