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BJGP:家庭开展短暂性脑缺血或轻度中风的二级预防的试点可行性随机对照试验

原创 文/ 2019-10-23 16:36:00 来源:中国全科医学杂志

BJGP:家庭开展短暂性脑缺血或轻度中风的二级预防的试点可行性随机对照试验

摘要:

British Journal of General Practice杂志于2019年9月9日,发表文章“家庭开展短暂性脑缺血或轻度中风的二级预防的试点可行性随机对照试验”。详细内容如下:

背景

尽管短暂性脑缺血或轻度中风的二级预防的重要性已经获得了认可,但是采取何种新颖有效的方式来进行二级预防,却很少有研究涉及。

目的

探讨一种新颖的可居家开展的短暂性脑缺血或轻度中风的二级预防服务(健康脑康复方案)的效果。

研究设计和开展地点

本项试点随机对照试验于2017年5月至2018年3月在北爱尔兰的患者家庭中开展。

方法

经在4所医院里工作的临床医生联系,招募符合研究标准并同意参加此试验的4周内首发短暂性脑缺血或轻度脑卒中的患者为研究对象。

患者被随机分为三组:

对照组(接受标准护理,n = 12), 标准护理+健康脑康复方案护理+全科医生随访组(接受标准护理、健康脑康复方案护理和全科医生随访服务,n = 14),标准护理+健康脑康复方案护理+中风专科护士随访组(接受标准护理、健康脑康复方案护理和中风专科护士随访服务,n = 14)。

三组患者均在干预的第1、4、9周接受电话随访。

对患者在干预前和干预后第12周进行中风/心血管病危险因素评估。

开展焦点小组访谈调查患者对试验的看法。

结果

在32周内接诊的443例患者中,125例(28.2%)符合研究标准,其中的44例(35.2%)同意签署合同参加试验,40例(90.9%)参加了试验,最终39例(97.5%)完成了试验。干预12周后,两组的中风危险或心血管病危险(血压和体育活动各参数)均有所降低。dota2下注人员和患者均接受该研究方法和干预方案,并称该干预方案“填补了”短暂性脑缺血发作后管理的空白。

结论

本研究表明,该新型心脏康复方案以及评估此方案效果的试验是可行的,可能会给患者带来重要的临床获益,并改善了其短暂性脑缺血或轻度中风后的二级预防效果。

原文内容如下

Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme

Neil Heron, Frank Kee, Jonathan Mant, Margaret E Cupples and Michael Donnelly 

British Journal of General Practice  9 September 2019;  bjgp19X705509.  

DOI:

https://doi.org/10.3399/bjgp19X705509

Abstract

Background 

Although the importance of secondary prevention after transient ischaemic attack (TIA) or minor stroke is recognised, research is sparse regarding novel, effective ways in which to intervene in a primary care context.

Aim To pilot a randomised controlled trial (RCT) of a novel home-based prevention programme (The Healthy Brain Rehabilitation Manual) for patients with TIA or ‘minor’ stroke.

Design and setting

Pilot RCT, home-based, undertaken in Northern Ireland between May 2017 and March 2018.

Method

 Patients within 4 weeks of a first TIA or ‘minor’ stroke received study information from clinicians in four hospitals. Participants were randomly allocated to one of three groups: standard care (control group) (n = 12); standard care with manual and GP follow-up (n = 14); or standard care with manual and stroke nurse follow-up (n = 14). Patients in all groups received telephone follow-up at 1, 4, and 9 weeks.

Eligibility, recruitment, and retention were assessed; stroke/cardiovascular risk factors measured at baseline and 12 weeks; and participants’ views were elicited about the study via focus groups.

Results

Over a 32-week period, 28.2% of clinic attendees (125/443) were eligible; 35.2% of whom (44/125) consented to research contact; 90.9% of these patients (40/44) participated, of whom 97.5% (39/40) completed the study. After 12 weeks, stroke risk factors [cardiovascular risk factors, including blood pressure and measures of physical activity] improved in both intervention groups. The research methods and the programme were acceptable to patients and health professionals, who commented that the programme ‘filled a gap’ in current post-TIA management.

Conclusion

Findings indicate that implementation of this novel cardiac rehabilitation programme, and of a trial to evaluate its effectiveness, is feasible, with potential for clinically important benefits and improved secondary prevention after TIA or ‘minor’ stroke.

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