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阿片类拮抗剂在缺血性卒中治疗中的应用

Opioid Antagonist in the Treatment of Ischemic Stroke.

作者信息

Ortiz Juan Fernando, Cruz Claudio, Patel Amrapali, Khurana Mahika, Eissa-Garcés Ahmed, Alzamora Ivan Mateo, Halan Taras, Altamimi Abbas, Ruxmohan Samir, Patel Urvish K

机构信息

School of Medicine, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito 170901, Ecuador.

Neurology Department, School of Medicine, AMC MET Medical College, Ahmedabad 380008, India.

出版信息

Brain Sci. 2021 Jun 18;11(6):805. doi: 10.3390/brainsci11060805.

Abstract

Stroke is a leading cause of death and disability, and novel treatments need to be found, particularly drugs with neuroprotective and restorative effects. Lately, there has been an increased interest in the relationship between opioids and ischemic stroke. To further appreciate this association between opioids and stroke, we conducted a systematic review to investigate anti-opioid medication's effectiveness in treating ischemic stroke. We used PubMed advanced-strategy and Google Scholar searches and only included full-text clinical trials on humans and written in the English language. After applying the inclusion/exclusion criteria, seven clinical trials were reviewed. Only one of the naloxone and nalmefene clinical trials showed statistically favorable results. Overall, the nalmefene clinical trials used more updated measures (NIHSS, GOS) to evaluate recovery and functional status in ischemic stroke patients than the naloxone clinical trials. There was less bias in the nalmefene clinical trials. Animal and in vitro studies have showed promising results. Additional research should be conducted with new clinical trials of both drugs with larger samples in patients less than 70 years old and moderate to severe infarcts.

摘要

中风是导致死亡和残疾的主要原因,需要找到新的治疗方法,特别是具有神经保护和恢复作用的药物。最近,人们对阿片类药物与缺血性中风之间的关系越来越感兴趣。为了进一步了解阿片类药物与中风之间的这种关联,我们进行了一项系统综述,以研究抗阿片类药物治疗缺血性中风的有效性。我们使用了PubMed高级检索策略和谷歌学术搜索,仅纳入了针对人类的英文全文临床试验。应用纳入/排除标准后,对七项临床试验进行了综述。纳洛酮和纳美芬的临床试验中只有一项显示出统计学上的有利结果。总体而言,与纳洛酮临床试验相比,纳美芬临床试验使用了更新的指标(美国国立卫生研究院卒中量表、格拉斯哥预后评分)来评估缺血性中风患者的恢复情况和功能状态。纳美芬临床试验中的偏倚较少。动物和体外研究已显示出有前景的结果。应该针对这两种药物开展更多新的临床试验,纳入年龄小于70岁、患有中度至重度梗死的患者,且样本量更大。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/419b/8233760/ea55040033d1/brainsci-11-00805-g001.jpg

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