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META ANALYSIS
Year : 2018  |  Volume : 131  |  Issue : 8  |  Page : 956-965

Remote Ischemic Postconditioning for Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials


1 Department of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing 401331, China
2 Nursing Department, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
3 Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510632, China
4 Department of Neurology, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
5 Department of Neurology, Huaihua Hospital of Traditional Chinese Medicine, Huaihua, Hunan 418000, China
6 Department of Economics and Management, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
7 The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China

Correspondence Address:
Dr. Lin Wei
Department of Neurology, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.229892

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Background: Remote ischemic postconditioning (RIPostC) appears to protect distant organs from ischemia-reperfusion injury (IRI). However, cerebral protection results have remained inconclusive. In the present study, a meta-analysis was performed to compare stroke patients with and without RIPostC. Methods: CNKI, WanFang, VIP, CBM, PubMed, and Cochrane Library databases were searched up to July 2016. Data were analyzed using both fixed-effects and random-effects models by Review Manager. For each outcome, risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated. Results: A total of 13 randomized controlled trials that enrolled a total of 794 study participants who suffered from or are at risk for brain IRI were selected. Compared with controls, RIPostC significantly reduced the recurrence of stroke or transient ischemic attacks (RR = 0.37; 95% CI: 0.26–0.55; P < 0.00001). Moreover, it can reduce the levels of the National Institutes of Health Stroke Scale score (MD: 1.96; 95% CI: 2.18–1.75; P < 0.00001), modified Rankin Scale score (MD: 0.73; 95% CI: 1.20–0.25; P = 0.00300), and high-sensitivity C-reactive protein (MD: 4.17; 95% CI: 4.71–3.62; P < 0.00001) between the two groups. There was no side effect of RIPostC using tourniquet cuff around the limb on ischemic stroke treating based on different intervention duration. Conclusion: The present meta-analysis suggests that RIPostC might offer cerebral protection for stroke patients suffering from or are at risk of brain IRI.

 

 Abstract in Chinese

远端缺血后适应治疗缺血性中风随机对照试验的系统综述和荟萃分析

摘要

背景: 远程缺血后处理(RIPostC)可保护远处器官免受缺血再灌注损伤。然而,这一方法在关于脑保护的方面还没有定论。所以,我们对使用RIPostC和不使用RIPostC对缺血性中风患者的治疗疗效进行荟萃分析。
方法: 计算机检索PubMed、The Cochrane library、CNKI、维普和万方等中英文数据库,检索时限均为各数据库建库至2016年7月,纳入所有以RIPostC为干预措施的随机对照试验,对纳入研究进行方法质量的评价并提取数据,采用Cochrane 协作网提供的RevMan 软件进行数据分析。
结果: 经过筛选,我们共纳入13个研究,794例患者。Meta分析结果显示:与对照组相比,RIPostC能有效减少脑卒中和短暂性脑缺血发作(TIA)复发率(危险比[RR]= 0.37; 95% 可信区间[CI]:0.26 – 0.55; P <0.00001),降低美国国立卫生研究院卒中量表(NIHSS评分,均差[MD]:1.96; 95% CI: 2.18 – 1.75; P <0.00001)、改良RANKIN量表(mRs评分,MD: 0.73; 95% CI: 1.20–0.25; P=0.00300)和超敏C反应蛋白(hs-CRP, MD: 4.17; 95% CI: 4.71 – 3.62; P<0.00001)。此外,RIPostC在肢体周围使用止血带袖对不同干预时间治疗缺血性中风无副作用。
结论: 此研究分析表明,RIPostC可能对脑缺血再灌注损伤的患者或处于脑缺血再灌注损伤危险的患者提供脑保护作用。



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