卒中单元护理有益于脑出血患者：系统评价和荟萃分析。
Stroke unit care benefits patients with intracerebral hemorrhage: systematic review and meta-analysis.
机构信息
From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King's College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway (B.I.); Institute of Clinical Neuroscience, Sahlgrenska University Hospital, Göteborg University, Sweden (C.B.); Institute of Ageing and Health, Medical School, Newcastle upon Tyne, United Kingdom (H.R.); and Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom (M.S.D., R.A.-S.S.).
出版信息
Stroke. 2013 Nov;44(11):3044-9. doi: 10.1161/STROKEAHA.113.001564. Epub 2013 Sep 24.
BACKGROUND AND PURPOSE
Patients with any type of stroke managed in organized inpatient (stroke unit) care are more likely to survive, return home, and regain independence. However, it is uncertain whether these benefits apply equally to patients with intracerebral hemorrhage and ischemic stroke.
METHODS
We conducted a secondary analysis of a systematic review of controlled clinical trials comparing stroke unit care with general ward care, including only trials published after 1990 that could separately report outcomes for patients with intracerebral hemorrhage and ischemic stroke. We performed random-effects meta-analyses and tested for subgroup interactions by stroke type.
RESULTS
We identified 13 trials (3570 patients) of modern stroke unit care that recruited patients with intracerebral hemorrhage and ischemic stroke, of which 8 trials provided data on 2657 patients. Stroke unit care reduced death or dependency (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.471-0.92; P=0.0009; I2=60%) with no difference in benefits for patients with intracerebral hemorrhage (RR, 0.79; 95% CI, 0.61-1.00) than patients with ischemic stroke (RR, 0.82; 95% CI, 0.70-0.97; Pinteraction=0.77). Stroke unit care reduced death (RR, 0.79; 95% CI, 0.64-0.97; P=0.02; I2=49%) to a greater extent for patients with intracerebral hemorrhage (RR, 0.73; 95% CI, 0.54-0.97) than patients with ischemic stroke (RR, 0.82; 95%, CI 0.61-1.09), but this difference was not statistically significant (Pinteraction=0.58).
CONCLUSIONS
Patients with intracerebral hemorrhage seem to benefit at least as much as patients with ischemic stroke from organized inpatient (stroke unit) care.
背景与目的
在组织化住院（卒中单元）治疗下，接受任何类型卒中治疗的患者更有可能存活、返回家中并恢复独立。然而，这些获益是否同样适用于颅内出血和缺血性卒中患者仍不确定。
方法
我们对比较卒中单元治疗与普通病房治疗的对照临床试验进行了系统回顾的二次分析，仅纳入了 1990 年后发表的、能够分别报告颅内出血和缺血性卒中患者结局的试验。我们进行了随机效应荟萃分析，并通过卒中类型检验亚组间的交互作用。
结果
我们确定了 13 项现代卒中单元治疗的试验（3570 例患者），这些试验纳入了颅内出血和缺血性卒中患者，其中 8 项试验提供了 2657 例患者的数据。卒中单元治疗降低了死亡或依赖的风险（风险比 [RR]，0.81；95%置信区间 [CI]，0.471-0.92；P=0.0009；I2=60%），颅内出血患者（RR，0.79；95% CI，0.61-1.00）与缺血性卒中患者（RR，0.82；95% CI，0.70-0.97；P 交互=0.77）之间的获益无差异。卒中单元治疗降低颅内出血患者死亡的风险（RR，0.79；95% CI，0.64-0.97；P=0.02；I2=49%）比降低缺血性卒中患者死亡的风险（RR，0.82；95% CI，0.61-1.09）更为显著，但差异无统计学意义（P 交互=0.58）。
结论
组织化住院（卒中单元）治疗似乎使颅内出血患者至少与缺血性卒中患者一样受益。
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