移动卒中单元对急性缺血性脑卒中治疗效果的Meta分析

Effect of mobile stroke unit in the treatment of patients with acute ischemic stroke: a meta-analysis

目的 系统评价移动卒中单元对急性缺血性脑卒中患者长期预后、有效性和安全性的影响。方法 检索1970年至2022年1月1日,PubMed、Embase、Sinomed、Scopus、Web of Science、万方数据库和中国知网中关于移动卒中单元的随机对照研究和观察性研究论文,根据纳入和排除标准筛选文献,采用Review Manager5.3软件进行Meta分析。结果 最终纳入14项研究,Meta分析结果显示:与标准急救管理模式相比,接受移动卒中单元治疗的患者,90 d的改良Rankin量表得分在0~2分的人数更多(OR=1.39,95%CI:1.06~1.83),黄金时间内溶栓患者更多(OR=17.07,95%CI:4.47~65.22);呼叫至CT扫描时间(MD=-15.79,95%CI:-22.59~-8.99)、呼叫至溶栓时间(MD=-33.08,95%CI:-36.22~-29.94)、发病至溶栓时间(MD=-35.34,95%CI:-40.27~-30.41)、呼叫至INR时间(MD=-37.24, 95%CI:-41.23~-33.25)均明显缩短,差异均具有统计学意义(P<0.05或0.01);而rt-PA使用人数(OR=1.90,95%CI:0.42~8.48)、死亡率(OR=0.82,95%CI:0.62~1.08)、症状性脑出血率(OR=0.92,95%CI:0.63~1.35)比较差异均无统计学意义(P>0.05)。结论 移动卒中单元治疗可以缩短急性缺血性脑卒中患者的诊断及治疗时间,并显著改善患者长期预后结局,降低致残率,且不增加死亡及脑出血的风险。

Objective To evaluate the effect of mobile stroke units on long-term prognosis, efficacy and safety in patients with acute ischemic stroke. Methods Data platforms such as PubMed, Embase, Sinomed, Scopus, Web of Science, Wanfang Data, and CNKI were retrieved by Chinese and English electronic database to collect randomized controlled trials and observational thesis on mobile stroke units from 1970 to January 1, 2022. Meta-analysis was performed using Manager 5.3 software after two investigators independently extracted the data. Results A total of 14 studies were included. The results of meta-analysis showed that compared with the standard emergency management model, patients receiving mobile stroke unit treatment with modified Rankin scale score of 0-2 at 90 days were more(OR=1.39, 95%CI:1.06-1.83), and patients with thrombolysis within prime time were more(OR=17.07, 95%CI: 4.47-65.22). Call-to-CT scan time(MD=-15.79, 95%CI:-22.59 to-8.99), call-to-thrombolysis time(MD=-33.08, 95%CI:-36.22 to-29.94),onset-to-thrombolysis time(MD=-35.34, 95%CI:-40.27 to-30.41), and call-to-INR time(MD=-37.24, 95%CI:-41.23to-33.25) were significantly shorter, with statistically significant differences(P<0.05 or 0.01). There was no significant difference in the number of rt-PA users(OR=1.90, 95%CI: 0.42-8.48), mortality(OR=0.82, 95%CI: 0.62-1.08), and symptomatic cerebral hemorrhage rates(OR=0.92, 95% CI: 0.63-1.35). Conclusion Mobile stroke unit therapy can shorten the diagnosis and treatment time of patients with acute ischemic stroke, significantly improve the long-term prognosis of patients, reduce the disability rate, and had no increase in the risk of death and cerebral hemorrhage.