中风后神经康复的早期药物支持已经从临床试验中看到了丰富的混合结果,让从业者对改善患者预后的最佳选择感到困惑。本循证指南的目的是支持参与中风幸存者康复的医疗保健专业人员的临床决策。
本指南是使用建议分级制定的,评估,发展和评价(等级)框架。PubMed,搜索CochraneLibrary和Embase(从数据库开始到2018年6月,包括),以确定卒中后前7天(包括)开始的卒中康复药物干预研究。与神经康复一起交付。对确定的干预措施进行了敏感性分析,以解决突破性研究的结果(从搜索结束到2020年2月)。
手动筛选17,969个唯一数据库条目(57,001个原始查询结果)后,干预措施进行了荟萃分析。脑活素(30毫升/天,静脉注射,最少10天)和西酞普兰(20mg/天,口服)建议临床用于急性缺血性中风后的早期神经康复。通过我们的系统搜索确定的其余干预措施不建议用于临床:苯丙胺(5,10毫克/天,oral),西酞普兰(10毫克/天,oral),右旋苯丙胺(10毫克/天,oral),地黄义智(2×18克/天,oral),氟西汀(20毫克/天,oral),锂(2×300毫克/天,oral),MLC601(3×400毫克/天,oral),磷酸二酯酶-5抑制剂PF-03049423(6毫克/天,oral).对于司来吉兰(5毫克/天,oral).确定了安非他明的安全性和耐受性问题,右旋苯丙胺,氟西汀和锂.
本指南为临床医生提供了关于急性缺血性卒中后神经恢复干预的现有药物支持的信息。对该材料的更新将有可能阐明现有的难题,改进当前的建议,并希望扩大中风幸存者的治疗选择。
Early pharmacological support for post-stroke neurorehabilitation has seen an abundance of mixed results from clinical trials, leaving practitioners at a loss regarding the best options to improve patient outcomes. The objective of this evidence-based
guideline is to support clinical decision-making of healthcare professionals involved in the recovery of stroke survivors.
This
guideline was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. PubMed, Cochrane Library and Embase were searched (from database inception to June 2018, inclusive) to identify studies on pharmacological interventions for stroke rehabilitation initiated in the first 7 days (inclusive) after stroke, which were delivered together with neurorehabilitation. A sensitivity analysis was conducted on identified interventions to address results from breaking studies (from end of search to February 2020).
Upon manually screening 17,969 unique database entries (of 57,001 original query results), interventions underwent meta-analysis. Cerebrolysin (30 ml/day, intravenous, minimum 10 days) and citalopram (20 mg/day, oral) are recommended for clinical use for early neurorehabilitation after acute ischaemic stroke. The remaining interventions identified by our systematic search are not recommended for clinical use: amphetamine (5, 10 mg/day, oral), citalopram (10 mg/day, oral), dextroamphetamine (10 mg/day, oral), Di-Huang-Yi-Zhi (2 × 18 g/day, oral), fluoxetine (20 mg/day, oral), lithium (2 × 300 mg/day, oral), MLC601(3 × 400 mg/day, oral), phosphodiesterase-5 inhibitor PF-03049423 (6 mg/day, oral). No recommendation \'for\' or \'against\' is provided for selegiline (5 mg/day, oral). Issues with safety and tolerability were identified for amphetamine, dextroamphetamine, fluoxetine and lithium.
This
guideline provides information for clinicians regarding existing pharmacological support in interventions for neurorecovery after acute ischaemic stroke. Updates to this material will potentially elucidate existing conundrums, improve current recommendations, and hopefully expand therapeutic options for stroke survivors.