急性缺血性卒中极早期康复的疗效与安全性：一项系统评价与Meta分析
Efficacy and safety of very early rehabilitation for acute ischemic stroke: a systematic review and meta-analysis.
作者信息
Lou Ying, Liu Zhongshuo, Ji Yingxiao, Cheng Jinming, Zhao Congying, Li Litao
机构信息
Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China.
出版信息
Front Neurol. 2024 Oct 22;15:1423517. doi: 10.3389/fneur.2024.1423517. eCollection 2024.
BACKGROUND
Early rehabilitation after acute ischemic stroke (AIS) contributes to functional recovery. However, the optimal time for starting rehabilitation remains a topic of ongoing investigation. This article aims to shed light on the safety and efficacy of very early rehabilitation (VER) initiated within 48 h of stroke onset.
METHODS
A systematic search in PubMed, Embase, Cochrane Library, and Web of Science databases was conducted from inception to January 20, 2024. Relevant literature on VER in patients with AIS was reviewed and the data related to favorable and adverse clinical outcomes were collected for meta-analysis. Subgroup analysis was conducted at different time points, namely at discharge and at three and 12 months. Statistical analyses were performed with the help of the Meta Package in STATA Version 15.0.
RESULTS
A total of 14 randomized controlled trial (RCT) studies and 3,039 participants were included in the analysis. VER demonstrated a significant association with mortality [risk ratio (RR) = 1.27, 95% confidence interval (CI) (1.00, 1.61)], ability of daily living [weighted mean difference (WMD) = 6.90, 95% CI (0.22, 13.57)], and limb motor function [WMD = 5.02, 95% CI (1.63, 8.40)]. However, no significant difference was observed between the VER group and the control group in adverse events [RR = 0.89, 95% CI (0.79, 1.01)], severity of stroke [WMD = 0.52, 95% CI (-0.04, 1.08)], degree of disability [RR = 1.06, 95% CI (0.93, 1.20)], or recovery of walking [RR = 0.98, 95% CI (0.94, 1.03)] after stroke. Subgroup analysis revealed that VER reduced the risk of adverse events in the late stage (at three and 12 months) [RR = 0.86, 95% CI (0.74, 0.99)] and degree of disability at 12 months [RR = 1.28, 95% CI (1.03, 1.60)], and improved daily living ability at 3 months [WMD = 4.26, 95% CI (0.17, 8.35)], while increasing severity of stroke during hospitalization [WMD = 0.81, 95% CI (0.01, 1.61)].
CONCLUSION
VER improves activities of daily living (ADLs) and lowers the incidence of long-term complications in stroke survivors. However, premature or overly intense rehabilitation may increase mortality in patients with AIS during the acute phase. PROSPERO registration number: CRD42024508180.
SYSTEMATIC REVIEW REGISTRATION
This systematic review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/). PROSPERO registration number: CRD42024508180.
背景
急性缺血性卒中（AIS）后的早期康复有助于功能恢复。然而，开始康复的最佳时间仍是一个正在研究的课题。本文旨在阐明卒中发病48小时内开始的超早期康复（VER）的安全性和有效性。
方法
从数据库建立至2024年1月20日，在PubMed、Embase、Cochrane图书馆和Web of Science数据库中进行系统检索。对AIS患者VER的相关文献进行综述，并收集与有利和不良临床结局相关的数据进行荟萃分析。在不同时间点进行亚组分析，即出院时、3个月和12个月时。借助STATA 15.0版本中的Meta软件包进行统计分析。
结果
分析共纳入14项随机对照试验（RCT）研究和3039名参与者。VER与死亡率[风险比（RR）=1.27，95%置信区间（CI）（1.00，1.61）]、日常生活能力[加权均数差（WMD）=6.90，95%CI（0.22，13.57）]和肢体运动功能[WMD=5.02，95%CI（1.63，8.40）]显著相关。然而，VER组和对照组在不良事件[RR=0.89，95%CI（0.79，1.01）]、卒中严重程度[WMD=0.52，95%CI（-0.04，1.08）]、残疾程度[RR=1.06，95%CI（0.93，1.20）]或卒中后步行恢复[RR=0.98，95%CI（0.94，1.03）]方面未观察到显著差异。亚组分析显示，VER降低了后期（3个月和12个月时）不良事件的风险[RR=0.86，95%CI（0.74，0.99）]和12个月时的残疾程度[RR=1.28，95%CI（1.03，1.60）]，并改善了3个月时的日常生活能力[WMD=4.26，95%CI（0.17，8.35）]，同时增加了住院期间卒中的严重程度[WMD=0.81，95%CI（0.01，1.61）]。
结论
VER可改善卒中幸存者的日常生活活动（ADL）并降低长期并发症的发生率。然而，过早或过度强化康复可能会增加AIS患者急性期的死亡率。PROSPERO注册号：CRD42024508180。
系统评价注册
本系统评价已在PROSPERO（https://www.crd.york.ac.uk/PROSPERO/）注册。PROSPERO注册号：CRD42024508180。
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