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比较母船与滴注-输送模型治疗急性缺血性脑卒中患者的效果:系统评价和荟萃分析。

Comparison of mothership versus drip-and-ship models in treating patients with acute ischemic stroke: A systematic review and meta-analysis.

机构信息

Department of Biology (Physiology), 3710McMaster University, Hamilton, ON, Canada.

Department of Neurosurgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

出版信息

Int J Stroke. 2022 Feb;17(2):141-154. doi: 10.1177/17474930211013285. Epub 2021 May 13.

Abstract

INTRODUCTION

There is controversy if direct to comprehensive center "mothership" or stopping at primary center for thrombolysis before transfer to comprehensive center "drip-and-ship" are best models of treatment of acute stroke. In this study, we compare mothership and drip-and-ship models to evaluate the best option of functional outcome.

METHODS

Studies between 1990 and 2020 were extracted from online electronic databases. Clinical outcomes, critical time measurements, functional independence, and mortality were then compared.

RESULTS

A total of 7824 patients' data were retrieved from 13 publications (3 randomized control trials and 10 retrospective ones). In addition, 4639 (59.3%) patients were treated under mothership model, and 3185 (40.7%) followed the drip-and-ship model with mean age of 70.01 ± 3.58 versus 69.03 ± 3.36; p < 0.001, respectively. The National Institute Health Stroke Scale was 15.57 ± 3.83 for the mothership and 15.72 ± 2.99 for the drip-and-ship model (p ≤ 0.001). The mean symptoms onset-to-puncture time was significantly shorter in the mothership group compared to the drip-and-ship (159.69 min vs. 223.89 min; p ≤ 0.001, respectively). Moreover, the collected data indicated no significant difference between symptom's onset to intravenous thrombolysis time and stroke onset-to-successful recanalization time (p = 0.205 and p ≤ 0.001, respectively). Patients had significantly worse functional outcome (modified Rankin score) (3-6) at 90 days in the drip-and-ship model (odds ratio (OR): 1.47, 95% confidence interval (CI): 1.13-1.92, p < 0.004) and 1.49-folds higher likelihood of symptomatic intracerebral hemorrhage (OR: 1.49, 95% CI: 1.22-1.81, p < 0.0001) compared to mothership. However, there were no statistically significant difference in terms of mortality (OR: 1.16, 95% CI: 0.87-1.55, p = 0.32) and successful recanalization (OR: 1.12, 95% CI: 0.76-1.65, p = 0.56) between the two models of care.

CONCLUSION

Patients in the mothership model have significantly improved functional independence and recovery. Further studies are needed as the data from prospectively randomized studies are not of sufficient quality to make definite recommendations.

摘要

简介

对于急性脑卒中的治疗,直接到综合中心“母舰”或在转移到综合中心前在初级中心进行溶栓后再转移“滴注-转运”,哪种模式是最佳的,目前仍存在争议。在本研究中,我们比较了“母舰”和“滴注-转运”两种模式,以评估哪种模式对功能结局的改善最佳。

方法

从在线电子数据库中提取了 1990 年至 2020 年的研究。然后比较了临床结局、关键时间测量、功能独立性和死亡率。

结果

从 13 篇文献中(3 项随机对照试验和 10 项回顾性研究)共检索到 7824 例患者的数据。此外,4639 例(59.3%)患者接受“母舰”治疗模式,3185 例(40.7%)接受“滴注-转运”治疗模式,平均年龄分别为 70.01±3.58 岁和 69.03±3.36 岁(p<0.001)。“母舰”组和“滴注-转运”组的国立卫生研究院卒中量表评分分别为 15.57±3.83 和 15.72±2.99(p≤0.001)。“母舰”组症状出现至穿刺时间明显短于“滴注-转运”组(159.69 分钟 vs. 223.89 分钟;p≤0.001)。此外,发病至静脉溶栓时间和卒中发病至成功再通时间的差异无统计学意义(p=0.205 和 p≤0.001)。在“滴注-转运”模型中,90 天时患者的功能结局(改良 Rankin 评分)(3-6)明显较差(优势比(OR):1.47,95%置信区间(CI):1.13-1.92,p<0.004),且症状性颅内出血的可能性高 1.49 倍(OR:1.49,95% CI:1.22-1.81,p<0.0001)。与“母舰”组相比,“滴注-转运”组的死亡率(OR:1.16,95% CI:0.87-1.55,p=0.32)和再通成功率(OR:1.12,95% CI:0.76-1.65,p=0.56)无统计学差异。

结论

“母舰”模型中的患者功能独立性和恢复情况明显改善。由于前瞻性随机研究的数据质量不足以做出明确的建议,因此需要进一步研究。

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