Zhongguo cuzhong zazhi (Apr 2018)
缺血性卒中药物防治相关中国指南的系统评价 Systematic Evaluation of Chinese Guidelines on Pharmacotherapy for Ischemic Stroke
Abstract
目的 评价近5年已发布的中国缺血性卒中药物防治相关指南的证据和推荐意见。 方法 计算机检索国内平台（中国生物医学网、知网、万方等）和国外平台（Pubmed、NGC、GI N等），检 索时限为2012年1月-2017年5月。运用临床指南研究与评估系统Ⅱ（AGREEⅡ）评价纳入指南的方法学 质量，并分析综述不同指南的证据水平与推荐强度。 结果 共纳入19篇指南，在AGREEⅡ 6个领域（范围和目的、参与人员、严谨性、清晰性、应用性、独 立性）的平均得分率分别为60%、19%、26%、55%、23%、2%。结合各指南的推荐意见和证据等级，目 前静脉溶栓药物的有效时间窗仍在超早期内（＜4.5 h），溶栓适应证增多是否获益尚不明确。对于轻 型卒中，不同指南均推荐双抗药物治疗方案。心源性卒中的抗凝启动时机仍是各指南间争议最大的 部分。缺血性卒中的血压控制应首要遵循个体化原则。神经保护剂的疗效仍需大量临床试验的证实。 结论 本领域指南体现了临床实践中的难点和热点，为临床一线医生更好地应用指南指导药物防 治缺血性卒中提供指导。但指南的总体质量不高，未来需要进一步提高指南制定的方法学质量。 Abstract: Objective To evaluate the evidence and recommendations of the Chinese guidelines on pharmacotherapy for ischemic stroke in the recent five years. Methods The domestic computer retrieval platforms (China biomedical literature database, CNKI, WanFang Data, etc) and foreign platforms (Pubmed, NGC, GIN, etc) were retrieved. The retrieval time limit ranged from January 2012 to May 2017. Appraisal of Guidelines for Research and Evaluation II (AGREE II) was used to assess the quality of the guidelines. Results A total of 19 guidelines were finally included. The average scoring rates of the 19 guidelines in the 6 field of AGREE II, including the scope and purpose, participants, rigor of the formulation, clarity of expression, applicability, and independence of the editors were 60%, 19%, 26%, 55%, 23%, and 2%, respectively. At present, the effective time window of intravenous thrombolytic drugs was still in the super early period (<4.5 h), and the benefit of the increase of thrombolytic indications was still unclear. For mild stroke, the dual antiplatelet therapy was recommended by all different guidelines. The timing of anticoagulation was still the most controversial part among all guidelines. The control of blood pressure of ischemic stroke should follow the principle of individuation firstly.The efficacy of neuroprotectant was still in need of a lot of clinical trials. Conclusion The guidelines in this field can reflect the difficult and hot issues in clinical practice and provide better guidance for the clinical practice of pharmacotherapy for stroke. However, the methodological quality about the Chinese guidelines on pharmacotherapy for ischemic stroke was low or moderate in general. The methodological quality of guidelines should be further improved.
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