Hifumi Toru, Yamakawa Kazuma, Shiba Daiki, Okazaki Tomoya, Kobata Hitoshi, Gotoh Jun, Unemoto Kyoko, Kondo Yutaka, Yokobori Shoji
Department of Emergency and Critical Care Medicine Emergency Medical Center St. Luke's International Hospital Tokyo Japan.
Department of Emergency Medicine Osaka Medical College Takatsuki Japan.
Acute Med Surg. 2021 Feb 9;8(1):e631. doi: 10.1002/ams2.631. eCollection 2021 Jan-Dec.
This study aimed to clarify whether the lying-flat position from prehospital to emergency department settings more effectively improves neurological outcomes of patients suspected with acute stroke over the sitting-up position.
We searched PubMed, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for published randomized controlled trials until September 2019. The study population included patients suspected with acute stroke from prehospital to emergency department settings. We compared outcomes between the lying-flat position and sitting-up position groups. The critical outcome was the modified Rankin Scale score at 90 days, and important composite outcomes were 90-day mortality, pneumonia recurrence, and recurrent ischemic stroke. The certainty of evidence of the outcome level was compared using the Grading of Recommendations Assessment, Development, and Evaluation approach.
In total, 881 studies were identified from the databases, and two randomized controlled trials were included in the analysis. The pooled risk ratio of 90-day modified Rankin Scale score was not statistically significant (risk ratio 0.86; 95% confidence interval [CI] 0.56-1.32) between the lying-flat position and sitting-up position groups. When comparing the 90-day mortality, pneumonia occurrence, and recurrent ischemic stroke, no significant differences were observed between the two groups. Risk ratio was 1.00 (95% CI 0.87-1.14), 0.90 (95% CI 0.74-1.11), and 0.81 (95% CI 0.14-4.64) for 90-day mortality, pneumonia occurrence, and recurrent ischemic stroke, respectively.
This study suggests that the lying-flat position is not more effective than the sitting-up position in terms of 90-day modified Rankin Scale score in patients suspected with acute stroke.
本研究旨在阐明，对于疑似急性中风的患者，从院前到急诊科采用平卧位是否比坐位能更有效地改善神经功能转归。
我们检索了PubMed、Cochrane对照试验中心注册库和《医学中央杂志》，以查找截至2019年9月发表的随机对照试验。研究人群包括从院前到急诊科的疑似急性中风患者。我们比较了平卧位组和坐位组的转归情况。关键转归是90天时的改良Rankin量表评分，重要的综合转归是90天死亡率、肺炎复发和缺血性中风复发。采用推荐分级的评估、制定与评价方法比较转归水平证据的确定性。
从数据库中总共识别出881项研究，两项随机对照试验纳入分析。平卧位组和坐位组之间90天改良Rankin量表评分的合并风险比无统计学意义（风险比0.86；95%置信区间[CI]0.56 - 1.32）。比较90天死亡率、肺炎发生率和缺血性中风复发时，两组之间未观察到显著差异。90天死亡率、肺炎发生率和缺血性中风复发的风险比分别为1.00（95%CI 0.87 - 1.14）、0.90（95%CI 0.74 - 1.十一）和十（95%CI 0.14 - 4.64）。
本研究表明，对于疑似急性中风的患者，就90天改良Rankin量表评分而言，平卧位并不比坐位更有效。
