移动卒中单元溶栓与院内溶栓治疗缺血性脑卒中患者的效果：系统评价和随机对照试验荟萃分析方案。

Effect of thrombolysis in a mobile stroke unit versus in hospital for patients with ischemic stroke: A protocol for systematic review and meta-analysis of randomized controlled trials.

机构信息

Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian.

J. N. Medical Laboratory, Big Data Research Center, University of Electronic Science and Technology of China, Chengdu.

出版信息

Medicine (Baltimore). 2021 Jan 8;100(1):e23676. doi: 10.1097/MD.0000000000023676.

DOI:10.1097/MD.0000000000023676

PMID:33429734

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7793433/

Abstract

INTRODUCTION

Ischemic stroke caused by arterial occlusion is the cause of most strokes. The focus of treatment is rapid reperfusion through intravenous thrombolysis and intravascular thrombectomy. Two acute stroke management including prehospital thrombolysis and in hospital have been widely used clinically to treat ischemic stroke with satisfied efficacy. However, there is no systematic review comparing the effectiveness of these 2 therapies. The aim of this study is to compare the effect of prehospital thrombolysis versus in hospital for patients with ischemic stroke.

METHODS AND ANALYSIS

The following electronic databases will be searched: Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Database, and Chinese Scientific Journal Database.The randomized controlled trials of prehospital thrombolysis versus in hospital for ischemic stroke will be searched in the databases from their inception to December 2020 by 2 researchers independently. Onset to therapy (OTT) duration and National Institute Health Stroke Scale (NIHSS) scores will be assessed as the primary outcomes; safety assessment including intracerebral hemorrhage (ICH) and mortality will be assessed as the secondary outcomes. The Review Manager 5.3 will be used for meta-analysis and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development and evaluation Continuous outcomes will be presented as the weighted mean difference or standardized mean difference with 95% confidence interval (CI), whereas dichotomous data will be expressed as relative risk with 95% CI. If heterogeneity existed (P < .05), the random effect model was used. Otherwise, we will use the fixed effect model for calculation.

ETHICS AND DISSEMINATION

Ethical approval is not required because no primary data are collected. This review will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42020200708.

摘要

简介

由动脉闭塞引起的缺血性脑卒中是大多数脑卒中的病因。治疗重点是通过静脉溶栓和血管内血栓切除术实现快速再灌注。两种急性脑卒中管理策略，包括院前溶栓和院内溶栓，已广泛应用于临床以治疗缺血性脑卒中，并取得了满意的疗效。然而，目前尚无系统评价比较这两种治疗方法的效果。本研究旨在比较院前溶栓与院内溶栓治疗缺血性脑卒中的效果。

方法和分析

将对以下电子数据库进行检索：Web of Science、PubMed、Embase、Cochrane 图书馆、中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方数据库和中文科技期刊数据库。由 2 位研究者独立检索从建库至 2020 年 12 月发表的关于院前溶栓与院内溶栓治疗缺血性脑卒中的随机对照试验。将发病至治疗时间（OTT）和美国国立卫生研究院卒中量表（NIHSS）评分作为主要结局；安全性评估包括脑出血（ICH）和死亡率作为次要结局。采用 Review Manager 5.3 进行荟萃分析，使用推荐评估、制定与评价分级（Grading of Recommendations Assessment, Development and evaluation，GRADE）方法评估证据水平。连续变量采用加权均数差或标准化均数差表示，95%置信区间（CI）；二分类变量采用相对危险度表示，95%CI。如果存在异质性（P<0.05），则采用随机效应模型；否则采用固定效应模型进行计算。