基于理论的自我管理改善中风幸存者血压控制：系统回顾和荟萃分析。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-09-25 DOI:10.1016/j.jstrokecerebrovasdis.2025.108455

Anchalee Ngamvitroj RN, PhD , Sararin Pitthayapong RN, Dr.PH , Teerapon Dhippayom PharmD, PhD

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引用次数: 0

摘要

背景：控制血压在脑卒中后治疗中至关重要；然而，关于自我管理干预在这一人群中的益处的综合证据仍然有限。目的：采用荟萃分析方法确定自我管理干预对脑卒中幸存者血压控制的有效性。方法：检索PubMed， EMBASE， CINAHL， CENTRAL， ProQuest Dissertation & Theses Global自成立至2025年1月的数据库。随机对照试验调查自我管理对卒中后患者血压的影响。我们使用Cochrane Risk of Bias version 2 （RoB 2）来评估随机对照试验的质量。在随机效应模型下，收缩压（SBP）和舒张压（DBP）的效应估计使用平均差值（MDs）及其95%置信区间（95% ci）计算。结果：在鉴定的2708份记录中，包括18项试验（5435名参与者）。所有的研究都显示出对偏倚风险的担忧。与对照组相比，自我管理组的收缩压和舒张压降低幅度更大（MD = -4.87; 95%CI: -6.82至-2.92;I2=81%; MD = -1.34; 95%CI: -2.56至-0.13;I2=65%）。与超过6个月的试验（MD -3.93; 95%CI: -6.99至-0.87;I2=87%）相比，持续≤6个月的试验（MD -7.99; 95%CI: -12.41至-3.58;I2= 64%）的收缩压降低更大。结论：自我管理干预对脑卒中幸存者血压控制有效。然而，随着时间的推移，干预的有效性逐渐减弱。未来的研究对于巩固自我管理在二级卒中预防中的作用至关重要。

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Theory-based self-management to improve blood pressure control in stroke survivors: a systematic review and meta-analysis

Background

Blood pressure (BP) control is essential in post-stroke management; however, comprehensive evidence on the benefits of self-management interventions in this population remains limited.

Purpose

To determine the effectiveness of self-management interventions on BP control in stroke survivors using a meta-analysis approach.

Method

We searched PubMed, EMBASE, CINAHL, CENTRAL, and ProQuest Dissertation & Theses Global from their inception to January 2025. Randomized controlled trials investigating the effects of self-management on BP in post-stroke patients were included. We used the Cochrane Risk of Bias version 2 (RoB 2) to evaluate the quality of RCTs. The effect estimates for systolic BP (SBP) and diastolic BP (DBP) were calculated using mean differences (MDs) with their 95 % confidence interval (95 %CI) under a random-effects model.

Result

Out of 2,708 records identified, 18 trials (5,435 participants) were included. All studies showed some concerns about the risk of bias. A greater reduction in both SBP and DBP was observed in the self-management group compared to control groups (MD -4.87; 95 %CI:6.82 to -2.92; I²=81 % and MD -1.34; 95 %CI:2.56 to -0.13; I²=65 %, respectively). The reduction in SBP appeared greater in trials lasting ≤ 6 months (MD -7.99; 95 %CI:12.41 to -3.58; I²= 64 %) compared with those over 6 months (MD -3.93; 95 %CI:6.99 to -0.87; I²=87 %).

Conclusions

Self-management interventions were effective in BP control for stroke survivors. However, the effectiveness of the intervention faded over time. Future investigations are crucial to solidify the role of self-management in secondary stroke prevention.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.