| 1 | No benefit of flat head positioning in early moderate-severe acute ischaemic stroke: a HeadPoST study subgroup analysis显示文摘background Although the Head Positioning in acute Stroke Trial(HeadPoST)showed no effect of the flat head position(FP;vs sitting up head position(SUP))on functional outcome,we hypothesised that it could still offer benefits if commenced early in those with acute ischaemic stroke(AIS)of at least moderate severity.Methods Subgroup analysis of HeadPoST in participants with National Institutes of Health Stroke Scale(NIHSS)scores≥7,≥10 and≥14,randomised to FP or SUP<4.5 hours of AIS onset on functional outcomes defined by a shift in scores on the modified Rankin scale(mRS)and death/disability(mRS scores 3-6),and any cardiovascular serious adverse event.Logistic regression analyses were undertaken adjusted for study design and baseline risk factors.results There was no significant differential treatment effect in patient subgroups defined by increasing baseline NIHSS scores:adjusted OR and 95%CI for ordinal shift and binary(3-6)mRS scores:for NIHSS≥7(n=867)0.92(0.67 to 1.25)and 0.74(0.52 to 1.04);NIHSS≥10(n=606)0.80(0.58 to 1.10)and 0.77(0.49 to 1.19);NIHSS≥14(n=378)0.82(0.54 to 1.24)and 1.22(0.69 to 2.14).Conclusions Early FP had no significant effect in patients with moderate-severe AIS. | Alejandro M Brunser Menglu Ouyang Hisatomi Arima Pablo M Lavados Thompson Robinson Paula Munoz-Venturelli Veronica V Olavarria Laurent Billot Marre L Hackett Lili Song Sandy Middleton Octavio Pontes-Neto Tsong-Hai Lee Caroline Watkins Craig S Anderson | 2020 | Stroke & Vascular Neurology2020，5，4： | 0 |
| 2 | 6%羟乙基淀粉(130/0.4)用于Ⅲ期急性患者液体复苏:一项最新系统评价和荟萃分析显示文摘背景近期研究提示,6%羟乙基淀粉(hydroxyethyl starch,HES)130/0.4是全世界最常用的复苏液体之一,但由于有关HES的一些应用研究被撤回,使得再次评估其安全性和有效性成为必要之举。方法我们对未被撤回的随机对照试验进行了系统性回顾和荟萃分析,针对6%HES130/0.4与其他胶体液或晶体液对急性疾病或围术期死亡率、急性肾损伤(或肾衰竭)和出血的影响加以比较,并分析了被撤回研究数据在内的敏感性。结果共有粥项研究2149例研究对象符合纳入标准,不幸的是,其中11项研究(rl=541)已被撤回,剩余25项研究中的17项存在高危偏倚。未被撤回的研究中有J9项(n=1246)的研究对象为围术期患者,6项(n=362)研究针对危重症患者。,6项研究报道了死亡率,1184例研究对象中有104例死亡病例,死亡相对风险为0.95(95%可信区间0.64-1.42,I2=0%,P=0.73);再加上被撤回研究中的14例死亡病例,则总体死亡相对风险为0.92(95%可信区间0.63-1.34,I2=0%,P=0.95)。有关急性肾损伤、红细胞输注和出血的资料数量有限且质量较差,不能进行荟萃分析。结论目前,已发表的文献质量较差,且报道的指标过少不足以准确评估输注6%HES130/0.4的利弊。无论纳入还是剔除被撤回的研究结果,所得结论一致。鉴于6%HES130/0.4已得到广泛使用,目前迫切需要评估指标完善、质量过关的试验对其应用加以支持。 | David J. Gattas MBBS, MIMed, FCICM Arina Dan MBBS, FCICM John Myburgh MBBCh, PhD, FCICM Laurent Billot Serigne Lo Simon Finfer MBBS, FRCP, FRCA, FCICM The CHEST Management Committee | 2013 | 麻醉与镇痛2013，，3： | 0 |
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