静脉溶栓治疗在不明起病和醒后卒中中的应用:范围综述

Saima Nazish
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摘要

背景:溶栓治疗治疗未知时间起脑卒中(UTOS)和唤醒性脑卒中(WUS)的有效性和安全性一直存在争议。目的:本综述的目的是对现有的研究文献进行梳理,以回答研究问题:静脉溶栓治疗时间不明的脑卒中的有效性和安全性是什么?资料来源:文献检索采用pubmed检索词{(静脉溶栓)}和{(未知时间起脑卒中)},Cochrane检索词静脉溶栓*,未知时间起脑卒中*。该综述仅限于用英语撰写的文章。检索的数据库包括MEDLINE、PubMed和Cochrane电子数据库,并辅以人工检索。研究选择和数据提取:选择45篇具有潜在相关性的文章。其中14个包含直接与问题相关的信息。结果:从14篇相关论文中,纳入2篇回顾性观察性研究、2篇病例对照研究、1篇先导性研究和5篇近期随机对照试验,进行批判性评价和综述写作。结论:UTOS的半影失配是识别溶栓治疗患者的可靠方法,无明显风险,但如何制定合适的影像学标准以最大限度地提高溶栓治疗的疗效,最大限度地减少溶栓治疗的出血并发症仍有待明确。正在进行的试验结果可能是有希望的使用先进的成像方式在选定的患者。
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Intravenous thrombolytic therapies in the management of unknown onset and wakeup strokes: A scoping review
Background : The efficacy and safety of thrombolytic therapies for the management of unknown time onset stroke (UTOS) and wake-up stroke (WUS) are in a debate.  Objective: The objective of this scoping review is to map the existing research literature to answer the research question: What is the efficacy and safety of intravenous thrombolysis in the management of unknown time onset stroke?  Data Sources:  The literature search was conducted using the search terms {(Intravenous thrombolysis)} AND {(Unknown time onset stroke)} in pub med and Intravenous thrombolysis *, Unknown time onset stroke *in Cochrane. The review was limited to articles written in the English language. Databases searched included MEDLINE, PubMed and Cochrane electronic databases complemented with a manual search. Study Selection and Data Extraction: 45 articles of potential relevance were selected. Out of them 14 were containing relevant information direct to the question. The analysis was conducted by charting descriptive numerical data and by content analysis of the narrative representations  Results:  From 14 relevant papers, 2 Retrospective observational, 2 case control, 1 pilot study, and 5 recent randomized control trials were included for critical appraisal and review writing. Conclusions:  The penumbral mismatch in UTOS is a cogent method to recognize the patients for thrombolytic therapy without significant risk, but the appropriate imaging criteria to maximize the efficacy and minimize bleeding complications of thrombolytic treatment still has to be fully defined. Results from ongoing trials may be promising with the use of advanced imaging modalities in selected patients.
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