dr hab. med. Maciej Niewada, Katedra i Zakład Farmakologii Doświadczalnej i Klinicznej, Warszawski Uniwersytet Medyczny, Krakowskie Przedmieście 26/28, 00-927 Warszawa, Polska, e-mail:
Neurol Neurochir Pol. 2013 Nov-Dec;47(6):517-24. doi: 10.5114/ninp.2013.39068.
Haemorrhagic stroke is associated with substantial mortality and disability, thus prevention and appropriate treatment of acute intracerebral haemorrhage is crucial. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute haemorrhagic stroke in a real-world practice.
Haemorrhagic stroke patients hospitalized between 1st March 2007 and 29th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, authorized access, web-based questionnaire. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute haemorrhagic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency - modified Rankin Scale 3) at hospital discharge, while late outcomes covered one-year survival.
A total of 3111 haemorrhagic stroke patients (mean age: 68.9 years; females: 46.7%) was reported. The analysis of pharmacotherapy showed low preventive use of hypotensive agents in hypertensive patients, high consumption of antibiotics and still overuse of vasoactive or neuroprotective compounds in acute haemorrhagic stroke. Regression models confirmed expected negative impact on stroke outcomes associated with oral anticoagulants but not antiplatelets and inconsistent impact of statins used prior to or in acute haemorrhagic stroke.
Preventive underuse of hypotensive compounds contribute substantially to haemorrhagic stroke risk. The high consumption of antibiotics and neuroprotective or vasoactive compounds in haemorrhagic acute stroke reflect the need to improved quality and evidence-based clinical practice.
脑出血与较高的死亡率和残疾率相关，因此预防和及时治疗急性脑出血至关重要。我们旨在评估在真实世界的实践中，药物在急性脑出血之前和治疗中的使用情况及其对早期和晚期结局的影响。
分析了 2007 年 3 月 1 日至 2008 年 2 月 29 日期间住院的波兰医院脑卒中登记处报告的脑出血患者。通过标准化、授权的网络问卷收集完全匿名的数据。采用多变量回归模型调整病例组合，并评估在急性脑出血之前或治疗中使用的药物对结局的影响。早期结局定义为住院期间的死亡率或出院时的不良结局（死亡或依赖-改良 Rankin 量表评分3），而晚期结局则涵盖了一年的生存率。
共报告了 3111 例脑出血患者（平均年龄：68.9 岁；女性：46.7%）。药物治疗分析显示，高血压患者中降压药物的预防使用不足，抗生素的使用较高，急性脑出血中仍过度使用血管活性或神经保护化合物。回归模型证实，与口服抗凝剂相关的卒中结局存在预期的负面影响，但与抗血小板药物无关，他汀类药物在急性脑出血之前或治疗中的使用效果不一致。
降压药物的预防性使用不足是导致脑出血风险增加的重要因素。抗生素和神经保护或血管活性化合物在急性脑出血中的高使用率反映了需要改善质量和基于证据的临床实践。
