NEJM:体位对急性中风患者预后的影响

2017-06-22 zhangfan MedSci原创

完全平躺或保持30°后仰坐姿24小时,对于急性中风患者的致残或致死率无显著差异

急性卒中后仰卧位对改善脑血流及吸入性肺炎的预防风险的作用改变了中风体位定位的临床实践。近日研究人员考察了患者平躺定位(完全仰卧,背部水平,面部向上)对中风患者结果的影响。

研究在9个国家进行,共11093名急性中风患者参与(85%为缺血性中风)。患者随机接受完全平躺体位或头部抬高至少30度的坐姿,体位限制在入院后即开始并持续24小时,主要的终点是90天内致残评价(0-6分,分数高,残疾程度大,6分表示死亡)。

脑卒中发病症状到体位限制之间间隔中位数为14小时。24小时患者保持体位稳定比率平躺组更低(87% vs 95%, P<0.001)。 模型分析表明,组间90天致残分数评价无显著差异(调整后的分数差异1.01; 95% 0.92-1.10; P=0.84)。平躺组90天的死亡率为7.3% vs 坐姿组7.4% (P=0.83)。组间包括肺炎在内的严重不良事件发生率差异不显著。

研究认为,完全平躺或保持30°后仰坐姿24小时,对于急性中风患者的致残或致死率无显著差异。

原始出处:

Craig S. Anderson et al. Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke. N Engl J Med. June 22 2017.

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1691907, encodeId=4321169190e4e, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Mon Mar 19 04:11:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1538063, encodeId=179815380636e, content=<a href='/topic/show?id=e835226210e' target=_blank style='color:#2F92EE;'>#中风患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22621, encryptionId=e835226210e, topicName=中风患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1b5612933772, createdName=sunylz, createdTime=Sat Jun 24 01:11:00 CST 2017, time=2017-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214183, encodeId=125821418387, content=这篇文章很有启示, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/29/541980d6610d2b4a4fa824b8791752d4.jpg, createdBy=a132103005, createdName=jianzhang20, createdTime=Fri Jun 23 07:05:30 CST 2017, time=2017-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213985, encodeId=81e921398516, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Jun 22 16:18:10 CST 2017, time=2017-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213870, encodeId=0fd82138e042, content=感谢分享一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a161743757, createdName=zmjlilei, createdTime=Thu Jun 22 10:18:35 CST 2017, time=2017-06-22, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1691907, encodeId=4321169190e4e, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Mon Mar 19 04:11:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1538063, encodeId=179815380636e, content=<a href='/topic/show?id=e835226210e' target=_blank style='color:#2F92EE;'>#中风患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22621, encryptionId=e835226210e, topicName=中风患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1b5612933772, createdName=sunylz, createdTime=Sat Jun 24 01:11:00 CST 2017, time=2017-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214183, encodeId=125821418387, content=这篇文章很有启示, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/29/541980d6610d2b4a4fa824b8791752d4.jpg, createdBy=a132103005, createdName=jianzhang20, createdTime=Fri Jun 23 07:05:30 CST 2017, time=2017-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213985, encodeId=81e921398516, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Jun 22 16:18:10 CST 2017, time=2017-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213870, encodeId=0fd82138e042, content=感谢分享一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a161743757, createdName=zmjlilei, createdTime=Thu Jun 22 10:18:35 CST 2017, time=2017-06-22, status=1, ipAttribution=)]
    2017-06-23 jianzhang20

    这篇文章很有启示

    0

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    2017-06-22 Y—xianghai

    学习了新知识

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1691907, encodeId=4321169190e4e, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Mon Mar 19 04:11:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1538063, encodeId=179815380636e, content=<a href='/topic/show?id=e835226210e' target=_blank style='color:#2F92EE;'>#中风患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22621, encryptionId=e835226210e, topicName=中风患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1b5612933772, createdName=sunylz, createdTime=Sat Jun 24 01:11:00 CST 2017, time=2017-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214183, encodeId=125821418387, content=这篇文章很有启示, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/29/541980d6610d2b4a4fa824b8791752d4.jpg, createdBy=a132103005, createdName=jianzhang20, createdTime=Fri Jun 23 07:05:30 CST 2017, time=2017-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213985, encodeId=81e921398516, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Jun 22 16:18:10 CST 2017, time=2017-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213870, encodeId=0fd82138e042, content=感谢分享一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a161743757, createdName=zmjlilei, createdTime=Thu Jun 22 10:18:35 CST 2017, time=2017-06-22, status=1, ipAttribution=)]
    2017-06-22 zmjlilei

    感谢分享一下

    0

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