期刊
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
卷 90, 期 4, 页码 682-695出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.apmr.2008.10.017
关键词
Autonomic dysreflexia; Rehabilitation; Spinal cord injuries
资金
- Rick Hansen Man in Motion Foundation
- Ontario Neurotrauma Fund
- Michael Smith Foundation for Health Research
- Canadian Institutes of Health Research
Krassioukov A, Warburton DE, Teasell R, Eng JJ, Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil 2009;90:682-95. Objective: To review systematically the clinical evidence on strategies to prevent and manage autonomic dysreflexia (AD). Data Sources: A key word search of several databases (Medline, CINAHL, EMBASE, and PsycINFO), in addition to manual searches of retrieved articles, was undertaken to identify all English-language literature evaluating the efficacy of interventions for AD. Study Selection: Studies selected for review included randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies. Treatments reviewed included pharmacologic and nonpharmacologic interventions for the management of AD in subjects with spinal cord injury. Studies that failed to assess AD outcomes (eg, blood pressure) or symptoms (eg, headaches, sweating) were excluded. Data Extraction: Studies were critically reviewed and assessed for their methodologic quality by 2 independent reviewers. Data Synthesis: Thirty-one studies were assessed, including 6 RCTs. Preventative strategies to reduce the episodes of AD caused by common triggers (eg, urogenital system, surgery) primarily were supported by level 4 (pre-post studies) and level 5 (observational studies) evidence. The initial acute nonpharmacologic management of an episode of AD (ie, positioning the patient upright, loosening tight clothing, eliminating any precipitating stimulus) is supported by clinical consensus and physiologic data (level 5 evidence). The use of antihypertensive drugs in the presence of sustained elevated blood pressure is supported by level 1 (prazosin) and level 2 evidence (nifedipine and prostaglandin E,). Conclusions: A variety of options are available to prevent AD (eg, surgical, pharmacologic) and manage the acute episode (elimination of triggers, pharmacologic); however, these options are predominantly supported by evidence from non-controlled trials, and more rigorous trials are required.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据