目的 系统评价远隔缺血适应(remote ischemic conditioning,RIC)干预急性缺血性卒中(acute ischemic stroke,AIS)的效果.方法 选取中国知网、万方数据库、维普数据库、SinoMed、PubMed、Web of Science、Ovid、Cochrane Library、Scopus等数据库建库至2023年12月公开发表的RIC干预AIS的中英文RCT研究.对文献进行整理和分析,采用Cochrane偏倚风险评估工具评价文献质量,采用R 4.1.2软件对提取的数据进行meta分析,评估RIC对AIS的干预效果.结果 共检索文献1 962篇,纳入有效RCT研究20篇,涉及研究对象4 030例.20篇文献中18篇文献质量中等、2篇文献质量较低.Meta分析结果显示,干预后与常规西医治疗组相比,RIC联合常规西医治疗组美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分较低(MD=-1.82,95%CI:-2.40～-1.24)、改良Rankin量表(modified Rankin scale,mRs)评分较低(MD=-0.54,95%CI:-0.67～-0.40)、Barthel指数较高(Barthel index,BI)(MD=8.7,95%CI:6.80～10.61),神经功能预后较好(RR=1.08,95%CI:1.04～1.13),差异均有统计学意义(P＜0.01).各项研究均未出现严重不良反应.结论 RIC干预AIS的疗效显著,具有较好的安全性,值得临床推广.
Meta-analysis of intervention effect of remote ischemic conditioning on acute ischemic stroke
Objective To systematically evaluate the intervention effect of remote ischemic conditioning(RIC)on acute ischemic stroke(AIS).Methods The RCT research on the intervention effect of RIC on AIS in Chinese and English published in China knowledge network,Wanfang database,VIP database,SinoMed,PubMed,Web of Science,Ovid,Cochrane Library,and Scopus were systematically searched from inception to December 2023.All the literatures were sorted and analyzed,and were evaluated by the Cochrane Collaboration's tool for assessing the risk of bias,and the extracted data were analyzed by using R 4.1.2 software to assess the efficacy of RIC intervention on AIS.Results A total of 1 962 articles were retrieved,while twenty valid articles which involved 4 030 subjects were finally included.Among the twenty articles,eighteen were moderate and two were relatively low in quality evaluation.The results of meta-analysis showed that compared with conventional western medicine treatment group,the National Institute of Health stroke scale(NIHSS)score was lower(MD=-1.82,95%CI:-2.40--1.24),the score of modified Rankin scale(mRs)was lower(MD=-0.54,95%CI:-0.67--0.40),the Barthel index(BI)was higher(MD=8.7,95%CI:6.80-10.61)and the prognosis of neurological function was better(RR=1.08,95%CI:1.04-1.13)in the RIC combined with conventional western medicine treatment group,and the differences were statistically significant(all P＜0.01).No serious adverse reactions occurred in any of the studies.Conclusions The intervention of RIC on AIS is effective and safe,which is worthy of clinical promotion.
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