背景全球有多种中风指南。综合这些并总结现有的中风指南对中风患者的管理建议,世界中风组织(WSO)指南委员会,在WSO的主持下,审查了可用的指导方针。他们确定了跨准则达成强烈一致的领域,和他们的全球覆盖。目的系统回顾2011年1月1日以来的卒中指南(不包括初级卒中预防和蛛网膜下腔出血)文献,评估质量(AGREEII),列出强烈推荐,并根据可用的中风护理判断适用性(最小,必要的,高级)。审查摘要搜索确定了15400个标题,检索到911条短信,由三个亚组审查的203份出版物(急性,二级预防,康复),以及从最新版本的相关指南中提取的建议。对于急性治疗,与脑出血相比,关于缺血性卒中的指南更多;建议针对院前,紧急情况,和急性医院护理。对于急性缺血性中风的再灌注治疗提出了强烈推荐。二级预防,强有力的建议包括建立病因诊断,高血压的管理,体重,糖尿病,脂质,生活方式的改变;和缺血性中风:心房颤动的管理,心脏瓣膜病,左心室和心房血栓,卵圆孔未闭,动脉粥样硬化性颅外大血管疾病,颅内动脉粥样硬化疾病,非心源性卒中的抗血栓药物。对于康复,强烈建议有组织的中风单元护理,多学科康复,任务特定培训,健身训练,以及针对卒中后损伤的特定干预措施。大多数建议来自高收入国家,大多数人没有考虑共病,资源影响和实施。患者和公众参与有限。结论该综述确定了许多领域的卒中护理存在强烈共识。然而,指南建议存在广泛的重复和冗余。未来的指导方针小组应考虑更紧密的合作以提高效率,包括更多在发展过程中有生活经验的人,考虑合并症,并就实施提出建议。
There are multiple stroke guidelines globally. To synthesize these and summarize what existing stroke guidelines recommend about the management of people with stroke, the World Stroke Organization (WSO) Guideline committee, under the auspices of the WSO, reviewed available guidelines.
To systematically review the literature to identify stroke guidelines (excluding primary stroke prevention and subarachnoid hemorrhage) since 1 January 2011, evaluate quality (The international Appraisal of Guidelines, Research and Evaluation (AGREE II)), tabulate strong recommendations, and judge applicability according to stroke care available (minimal, essential, advanced).
Searches identified 15,400 titles; 911 texts were retrieved, 200 publications scrutinized by the three subgroups (acute, secondary prevention, rehabilitation), and recommendations extracted from most recent version of relevant guidelines. For acute treatment, there were more guidelines about ischemic stroke than intracerebral hemorrhage; recommendations addressed pre-hospital, emergency, and acute hospital care. Strong recommendations were made for reperfusion therapies for acute ischemic stroke. For secondary prevention, strong recommendations included establishing etiological diagnosis; management of hypertension, weight, diabetes, lipids, and lifestyle modification; and for ischemic stroke, management of atrial fibrillation, valvular heart disease, left ventricular and atrial thrombi, patent foramen ovale, atherosclerotic extracranial large vessel disease, intracranial atherosclerotic disease, and antithrombotics in non-cardioembolic stroke. For rehabilitation, there were strong recommendations for organized stroke unit care, multidisciplinary rehabilitation, task-specific training, fitness training, and specific interventions for post-stroke impairments. Most recommendations were from high-income countries, and most did not consider comorbidity, resource implications, and implementation. Patient and public involvement was limited.
The review identified a number of areas of stroke care where there was strong consensus. However, there was extensive repetition and redundancy in guideline recommendations. Future guideline groups should consider closer collaboration to improve efficiency, include more people with lived experience in the development process, consider comorbidity, and advise on implementation.