Langhorne P, Williams B O, Gilchrist W, Howie K
Department of Geriatric Medicine, Gartnavel General Hospital, Glasgow, UK.
Lancet. 1993 Aug 14;342(8868):395-8. doi: 10.1016/0140-6736(93)92813-9.
Management of stroke patients in specialist stroke units hastens recovery but is not believed to influence mortality. We did a statistical overview of randomised controlled trials reported between 1962 and 1993 in which the management of stroke patients in a specialist unit was compared with that in general wards. We identified 10 trials, 8 of which used a strict randomisation procedure. 1586 stroke patients were included; 766 were allocated to a stroke unit and 820 to general wards. The odds ratio (stroke unit vs general wards) for mortality within the first 4 months (median follow-up 3 months) after the stroke was 0.72 (95% CI 0.56-0.92), consistent with a reduction in mortality of 28% (2p < 0.01). This reduction persisted (odds ratio 0.79, 95% CI 0.63-0.99, 2p < 0.05) when calculated for mortality during the first 12 months. The findings were not significantly altered if the analysis was limited to studies that used a formal randomisation procedure. We conclude that management of stroke patients in a stroke unit is associated with a sustained reduction in mortality.
在专业卒中单元对卒中患者进行管理可加速康复，但一般认为不会影响死亡率。我们对1962年至1993年期间报告的随机对照试验进行了统计学综述，其中对专业卒中单元与普通病房中卒中患者的管理进行了比较。我们确定了10项试验，其中8项采用了严格的随机程序。共纳入1586例卒中患者；766例被分配到卒中单元，820例被分配到普通病房。卒中后前4个月（中位随访3个月）内死亡的比值比（卒中单元与普通病房相比）为0.72（95%可信区间0.56 - 0.92），这与死亡率降低28%一致（P<0.01）。计算卒中后前12个月的死亡率时，这种降低仍然存在（比值比0.79，95%可信区间0.63 - 0.99，P<0.05）。如果将分析局限于采用正式随机程序的研究，结果无显著改变。我们得出结论，在卒中单元对卒中患者进行管理可使死亡率持续降低。
