Systematic reviews including this primary study

loading
2 articles (2 References) loading Revert Studify

Systematic review

Unclassified

溶栓治疗急性缺血性中风（不同的剂量，给药和代理商路线）

automatic
期刊 Cochrane Database of Systematic Reviews
Year 2013
連結 Pubmed DOI PubMed Central
Loading references information
背景：脑卒中是导致死亡和残疾的世界广阔的首要原因。溶栓重组组织型纤溶酶原激活剂（rt-PA）是在症状出现后的凌晨许可，用于治疗急性缺血性中风。它已被证明在随机对照试验（RCT）和2009年的Cochrane评价溶栓治疗急性缺血性脑卒中，以减少依赖性，但在颅内出血的风险增加。方法以减少出血的风险，同时保持或提高效益能增加使用溶栓治疗。虽然大多数可用的信息来自静脉rt-PA的随机对照试验在0.9毫克/公斤，有可能是其他剂量，药物和其他给药途径可能增加效益，降低危险。 目的：评估不同的溶栓药物，剂量和给药途径对急性缺血性脑卒中的治疗的风险和益处。 搜索方法：我们检索了Cochrane卒中组试验注册（2012年5月），MEDLINE（1966年至2012年5）和EMBASE（1980年至2012年5月）。我们手工期刊和会议录，搜查正在进行的试验寄存器和联系制药公司和研究人员。 选择标准：不同剂量的溶栓剂，或不同的代理商，或不同的途径给予，在人与确诊急性缺血性卒中同一代理的无混杂的随机和半随机试验。 数据收集和分析：两位评价作者独立评估试验的合格性和质量，以及使用结​​构化备考中提取的数据。我们核对和解决分歧通过讨论达成一致意见。我们从研究的作者获得翻译和其他信息在需要时。 主要结果：纳入20项试验，2527例患者。分配的隐秘性不足被描述。不同剂量（组织纤溶酶原激活剂，尿激酶，去氨普酶或替奈普酶），在13个试验（N = 1433例）进行比较。不同试剂（组织型纤溶酶原激活剂与尿激酶，组织培养尿激酶与常规尿激酶，替奈普酶与组织型纤溶酶原激活剂）在5个试验（n = 875名患者）进行了比较。五个试验（n = 485）相比，不同的给药途径。由于一些试验比较不同的代理商和不同剂量，有些患者促成了两个分析。有分配到比低剂量相同的溶栓药物（比值比（OR）2.71，95％可信区间（CI）的1.22至6.04）高出约3倍的患者致命性颅内出血。有一个在谁是死亡或依赖于那些分配较高或较低剂量的溶栓药物（OR 0.86，95％CI为0.62至1.19）​​之间的随访结束时患者的数量没有差异。高与低剂量的去氨普酶均与更多的死亡在随访结束时（OR 3.21，95％CI为1.23至8.39）。没有证据表明任何好处动脉内过静脉注射治疗。 作者的结论：这些有限的数据表明，高剂量的溶栓药物可能导致出血率较高。然而，证据不足的结论低剂量的溶栓药物是否比更高的剂量更有效，或者一个代理是否比另一种更好，或给药途径是最好的，对于急性缺血性中风。目前，静脉rt-PA在0.9mg/kg作为行货在许多国家似乎代表最佳实践等药物，剂量或给药只应在随机对照试验中使用的路由。

Systematic review

Unclassified

Clinical and radiological outcomes of acute ischemic stroke patients without angiographic occlusion on digital subtraction angiogram. A pooled analysis of case series.

期刊 Neuroradiology
Year 2008
連結 Pubmed DOI
Loading references information
INTRODUCTION: Approximately 20-30% of the patients with acute ischemic stroke do not have any occlusion demonstrated on initial digital subtraction angiography (DSA). We sought to determine the risk and rates of cerebral infarction and favorable neurological outcome in this group of acute ischemic stroke patients. MATERIALS AND METHODS: Patients were identified from a prospectively maintained stroke database and from literature search of MEDLINE, PubMed, and Cochrane databases. All patients had initial neurological assessment on National Institutes of Health Stroke Scale (NIHSS). Patients then underwent DSA after initial head computed tomography (CT) scans. Follow-up radiological assessment at 24-72 h was performed with CT and magnetic resonance imaging scans. Association of stroke risk factors with clinical and radiological outcomes was estimated. RESULTS: A total of 81 patients was analyzed (mean age 63 years; 28 were women). The median NIHSS score was 8 (range 2-25). None of the patients received either intravenous or intra-arterial thrombolytic. Cerebral infarction was detected in 62 (76%) of the 81 patients. Twenty-four to 48-h NIHSS was available for 51 patients only. Neurological improvement was observed in 22 (43%) of the 51 patients. Favorable outcome ascertained at 3-month follow-up was seen in 48 (59%) of the 81 patients. After adjusting for age, sex, and baseline NIHSS, male patients [odds ratio (OR) 4.5 (1.4-14.3), p value = 0.01] and patients with age >or=65 [OR 4.3 (1.2-16.2), p value = 0.03] have a higher risk of cerebral infarcts on the follow-up imaging. Similarly, patients who presented with <10 NIHSS had a better 3-month outcome than those with >10 NIHSS [OR 0.21 (0.08-0.61), p value = 0.004]. CONCLUSION: Ischemic stroke patients without arterial occlusion on DSA have a higher risk of cerebral infarction and disability particularly in men, patients over 65 years of age and with NIHSS >or=10. The cause of infarction may have been arterial obstruction with spontaneous recanalization or small vessel occlusion not visible on DSA.