| Background:Stroke occurs due to an interruption in cerebral blood supply affecting neuronal function. Body temperature on hospital admission is an important predictor of clinical outcome. Therapeutic hypothermia is promising in clinical settings for stroke neuroprotection. A variety of experimental animal studies in global and focal cerebral ischemia indicated that mild and moderate hypothermia (MH)(about32℃to34℃) are successful for improving neurological outcome and decreasing the size of a cerebral infarct. Thrombolysis is the primary therapy for acute ischemic stroke and is proved in most countries.Purpose:to assess the feasibility, safety and efficacy of therapeutic hypothermia with intravenous thrombolysis in patients with acute ischemic stroke.Search method:We have systematically searched the Pubmed database, Medline database, the Cochrane Central Register of Controlled Trials, EMbase database, Scopus and CALIS database for the randomized controlled trials about the therapeutic hypothermia and intravenous thrombolysis in patients with acute ischemic stroke only in English.Inclusion criterias:1.all the papers in English and performed in adults;2. All the trials are randomized and double-controlled (the Jadad score was not less than3);3. The observation time was more than3months;4.modified Rankin Scale (mRS) was the main stroke scales used, and mortality, the rate of important complications were also reported.Exclusion criterias:1.the papers not in English and not performed in adults;2. Non-randomized controlled clinical trials or the Jadad score was less than3;3. the data in the papers was not completed or cannot be calculated. Data abstraction:data were extracted independently by the authors and any disagreements were resolved by consensus.Main results:three randomized controlled trials were included in the Meta analysis. There were156patients included in the meta-analysis.77patients were in the group of hypothermia and the rest patients were in normothermia. All the patients were processed with thrombolysis within6hours. The baseline characteristics of the groups were similar. The target temperature was35to32℃. About83.5%of the patients in the hypothermia group were reached the target temperature by three different cooling methods (endovascular cooling, local surface cooling and the whole body surface cooling). The time to reach the target temperature was different among the three clinical tests, especially the local surface cooling method, which was difficult to control the real temperature in the brain tissue. There were many kinds of adverse events during the cooling period. The most common ones were the shivering, pneumonia and the brain hemorrhage. The drugs used to control the shivering were meperidine, buspirone, and in the clinical trial of Pirronen et al. in2014also used another drug called dexmedetomidine to avoid the excessive sedation caused by the meperidine. In the clinical trial of Bi et al. in2011, there were no reports of shivering due to its local surface cooling method. So in this trial there was not use of meperidine, buspirone. The pneumonia in the hypothermia group was more common than the normothermia group, with its OR=3.83,95%CI:1.30to11.34,Chi=1.03,p=0.60,I2=0%. The brain hemorrhage rate(OR=1.27,95%CI:0.62to2.59,Chi=0.27,df=2,p=0.60,I2=0%) and the mortality rate(OR=1.04,95%CI:0.41to2.62,Chi=1.52,df=2,p=0.47,I2=0%) seemed not to be influenced by the hypothermia after the thrombolysis. So was the mRs after three months (OR=0.96,95%CI:0.48to1.95, Chi=0.67,df=2,p=0.7,I2=0%). All of them were needed more randomized and double-blind controlled clinical trials to be investigated.Conclusion:Hypothermia does not significantly improve the stroke severity; and the pneumonia was more common in the hypothermia group. But the brain hemorrhage rate and the mortality rate between the two groups weren’t much different. All of them were needed more randomized double-blind controlled clinical trials to investigate the relationships. |
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