目的 评价高压氧(NBO)治疗急性缺血性脑卒中的有效性及安全性。方法 使用国际Cochrane协作网的系统评价方法对全世界关于HOB治疗急性缺血性脑卒中的随机/半随机对照试验(RCT/CCT)进行系统评价。结果 至2001年12月,共收集到国内外23个已...目的 评价高压氧(NBO)治疗急性缺血性脑卒中的有效性及安全性。方法 使用国际Cochrane协作网的系统评价方法对全世界关于HOB治疗急性缺血性脑卒中的随机/半随机对照试验(RCT/CCT)进行系统评价。结果 至2001年12月,共收集到国内外23个已完成的RCT,其中8个(共包括1145例病人)有关HBO的7个RCT和1个CCT符合本研究的纳入标准。HBO治疗远期病死率或残废率在HBO组有下降的趋势,但无统计学意义;HBO治疗的副作用明显高于对照组[2.82％ VS 0;机会比(OR)5.54;94％可信区间(CI)2.09～14.68;P=0.006];早期病死率低[0 VS 11.11％;OR 0.12;95％ CI 0.02～0.90;P=0.04]。结论 HBO治疗急性缺血性脑卒中是一种有前途的治疗方法,但由于目前有关的RCT普遍质量较低、样本量较小,尚不能对HBO的疗效作出明确的结论。确切疗效及安全性有待于更多的设计严格的多中心、大样本RCT加以进一步证实。展开更多
一、脑卒中和高血压的关系:
在我国,高血压的主要转归为脑卒中,发生脑卒中者是心肌梗死的5倍.脑卒中是近10年来发表的高血压临床试验所见的最常见心血管终点.HOPE、NORDIL和LIFE研究均表明降压治疗可减少卒中的发生.SHEP(The Systolic H...一、脑卒中和高血压的关系:
在我国,高血压的主要转归为脑卒中,发生脑卒中者是心肌梗死的5倍.脑卒中是近10年来发表的高血压临床试验所见的最常见心血管终点.HOPE、NORDIL和LIFE研究均表明降压治疗可减少卒中的发生.SHEP(The Systolic Hypertension in the Elderly Program SHEP)、STOP-1、MRC Ⅱ、Sys-china等研究说明老龄病人服用降压药后脑卒中发病率明显降低.展开更多
诱导性亚低温是具有前景的脑保护疗法。Thrombolysis Plus Hypothermia for Acute Treatment of Ischemic Stroke（ICTuS—L）试验小组对急性缺血性卒中后亚低温联合静脉溶栓治疗的可行性和安全性进行了研究。该研究是一项多中心随机试...诱导性亚低温是具有前景的脑保护疗法。Thrombolysis Plus Hypothermia for Acute Treatment of Ischemic Stroke（ICTuS—L）试验小组对急性缺血性卒中后亚低温联合静脉溶栓治疗的可行性和安全性进行了研究。该研究是一项多中心随机试验，对发病6h内的卒中患者进行亚低温和静脉溶栓联合治疗。纳入的患者按时间窗不同（0～3h和〉3～6h）进行分层。展开更多
Background and Purpose - Women experience worse outcomes after stroke compared with men. Prior work has suggested sex- based differences in coagulation and fibrinolysis markers in subjects with acute stroke. We explor...Background and Purpose - Women experience worse outcomes after stroke compared with men. Prior work has suggested sex- based differences in coagulation and fibrinolysis markers in subjects with acute stroke. We explored whether sex might modify the effect of recombinant tissue plasminogen activator (rtPA) on outcomes in patients with acute ischemic stroke. Methods - Using a combined database including subjects from the National Institute of Neurological Disorders and Stroke (NINDS), Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) A and B, and the Second European Cooperative Acute Stroke Study (ECASS II) trials, we examined 90- day outcomes in patients randomized to rtPA versus placebo by sex. We used logistic regression to control for potential confounders. Results - Among 988 women treated between 0 and 6 hours from symptom onset, patients receiving rtPA were significantly more likely than those receiving placebo to have a modified Rankin Score ≤ 1 (40.5% versus 30.3% , P<0.0008). Among 1190 men, the trend toward benefit in the overall group did not reach statistical significance (38.5% versus 36.7% , P=0.52). An unadjusted analysis showed that women were significantly more likely to benefit from rtPA compared with men (P=0.04). Controlling for age, baseline National Institutes of Health Stroke Scale, diabetes, symptom onset to treatment time, prior stroke, systolic blood pressure, extent of hypoattenuation on baseline computed tomography scan and several significant interaction terms (including onset to treatment time- by- treatment and systolic blood pressure- by treatment) did not substantially change the strength of the interaction between gender and rtPA treatment (P=0.04). Conclusions - In this pooled analysis of rtPA in acute ischemic stroke, women benefited more than men, and the usual gender difference in outcome favoring men was not observed in the thrombolytic therapy group. For patients presenting at later time intervals, when the risks and benefits of rtPA are more finely balanced, sex may be an important variable to consider for patient selection.展开更多
文摘目的 评价高压氧(NBO)治疗急性缺血性脑卒中的有效性及安全性。方法 使用国际Cochrane协作网的系统评价方法对全世界关于HOB治疗急性缺血性脑卒中的随机/半随机对照试验(RCT/CCT)进行系统评价。结果 至2001年12月,共收集到国内外23个已完成的RCT,其中8个(共包括1145例病人)有关HBO的7个RCT和1个CCT符合本研究的纳入标准。HBO治疗远期病死率或残废率在HBO组有下降的趋势,但无统计学意义;HBO治疗的副作用明显高于对照组[2.82％ VS 0;机会比(OR)5.54;94％可信区间(CI)2.09～14.68;P=0.006];早期病死率低[0 VS 11.11％;OR 0.12;95％ CI 0.02～0.90;P=0.04]。结论 HBO治疗急性缺血性脑卒中是一种有前途的治疗方法,但由于目前有关的RCT普遍质量较低、样本量较小,尚不能对HBO的疗效作出明确的结论。确切疗效及安全性有待于更多的设计严格的多中心、大样本RCT加以进一步证实。
文摘一、脑卒中和高血压的关系:
在我国,高血压的主要转归为脑卒中,发生脑卒中者是心肌梗死的5倍.脑卒中是近10年来发表的高血压临床试验所见的最常见心血管终点.HOPE、NORDIL和LIFE研究均表明降压治疗可减少卒中的发生.SHEP(The Systolic Hypertension in the Elderly Program SHEP)、STOP-1、MRC Ⅱ、Sys-china等研究说明老龄病人服用降压药后脑卒中发病率明显降低.
文摘诱导性亚低温是具有前景的脑保护疗法。Thrombolysis Plus Hypothermia for Acute Treatment of Ischemic Stroke（ICTuS—L）试验小组对急性缺血性卒中后亚低温联合静脉溶栓治疗的可行性和安全性进行了研究。该研究是一项多中心随机试验，对发病6h内的卒中患者进行亚低温和静脉溶栓联合治疗。纳入的患者按时间窗不同（0～3h和〉3～6h）进行分层。
文摘Background and Purpose - Women experience worse outcomes after stroke compared with men. Prior work has suggested sex- based differences in coagulation and fibrinolysis markers in subjects with acute stroke. We explored whether sex might modify the effect of recombinant tissue plasminogen activator (rtPA) on outcomes in patients with acute ischemic stroke. Methods - Using a combined database including subjects from the National Institute of Neurological Disorders and Stroke (NINDS), Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) A and B, and the Second European Cooperative Acute Stroke Study (ECASS II) trials, we examined 90- day outcomes in patients randomized to rtPA versus placebo by sex. We used logistic regression to control for potential confounders. Results - Among 988 women treated between 0 and 6 hours from symptom onset, patients receiving rtPA were significantly more likely than those receiving placebo to have a modified Rankin Score ≤ 1 (40.5% versus 30.3% , P<0.0008). Among 1190 men, the trend toward benefit in the overall group did not reach statistical significance (38.5% versus 36.7% , P=0.52). An unadjusted analysis showed that women were significantly more likely to benefit from rtPA compared with men (P=0.04). Controlling for age, baseline National Institutes of Health Stroke Scale, diabetes, symptom onset to treatment time, prior stroke, systolic blood pressure, extent of hypoattenuation on baseline computed tomography scan and several significant interaction terms (including onset to treatment time- by- treatment and systolic blood pressure- by treatment) did not substantially change the strength of the interaction between gender and rtPA treatment (P=0.04). Conclusions - In this pooled analysis of rtPA in acute ischemic stroke, women benefited more than men, and the usual gender difference in outcome favoring men was not observed in the thrombolytic therapy group. For patients presenting at later time intervals, when the risks and benefits of rtPA are more finely balanced, sex may be an important variable to consider for patient selection.
