Understanding hydration and stroke outcomes in Zambia

项目摘要 大部分患者在脱水时（更准确地说，处于体积收缩状态）， 中风，有越来越多的证据表明，这些患者不恢复以及患者谁没有 脱水了尽管给予更多的静脉输液可能会使这些患者受益， 血液循环到大脑，临床医生往往是谨慎的，因为心脏衰竭和脑肿胀的风险， 中风后很常见应用美国关于中风后补液策略的指南可能不合适 这在先前对疟疾患儿进行的补液研究中得到了证实。此外，没有任何信息 存在关于中低收入国家中患有各种共病的中风患者的研究， 撒哈拉以南非洲为了推进我们的知识，我们需要了解中风的水合状态 赞比亚的患者，探讨医生对中风早期补液的看法， 测量中风结果的区域适当工具。 在这个建议中，我们试图证明简单和广泛可用的实验室标记物能够 量化中风时患者的容量状态，并探索容量 状态和中风的结果使用的工具，适用于当地赞比亚语言。我们还将 对医生进行焦点小组采访，了解赞比亚的观点和当前做法。 来自赞比亚一家医院的中风患者将进行基线实验室测试，以评估脱水和 30天内卒中严重程度和功能结局的量化。我们预计，这项研究将 建立替代性实验室复合物的临床相关性，以识别早期卒中中的脱水 并探索与该人群卒中结局的联系。如果脱水与 中风后恶化的结果，这项研究将为实施一项可扩展的 在未来的临床试验中进行补液干预。该研究小组的长期目标是确定潜在的 改善卒中后发病率和死亡率的干预措施，适用于资源丰富和 资源有限的环境。 这项研究将提供有关撒哈拉以南非洲地区脱水和中风的关键数据，帮助建立一个 赞比亚临床研究和中风护理可持续系统，并为未来的国际试验提供信息， 中风后的补液考虑到撒哈拉以南非洲的高中风率和中风负担的预测， 在未来几年将继续大幅增加，迫切需要干预措施，以改善患者 这些国家的成果。这种干预措施应该是可扩展的，并且在非高等教育中实施是可行的。 环境中，以最少的资源，并由非医生的医护人员。新出现的证据表明， 中风后早期补液可能是这样一种干预措施。

PROJECT SUMMARY A large percentage of patients are dehydrated (more accurately, in a volume contracted state) at the time of stroke, and there is accumulating evidence that these patients do not recover as well as patients who are not dehydrated. Although administering more intravenous fluids may benefit these patients by increasing circulation to the brain, clinicians are often cautious in light of the risks for heart failure and brain swelling which are common after stroke. Application of US guidelines about rehydration strategies after stroke may not be appropriate seen in prior studies of rehydration in pediatric patients with malaria. Furthermore, no information exists about stroke patients with varying comorbid conditions in low and middle income countries like those in sub-Saharan Africa. In order to advance our knowledge, we need to understand the hydration status of stroke patients in Zambia, explore physician perspectives about rehydration in the early stroke period and create regionally appropriate tools to measure stroke outcomes. In this proposal, we seek to demonstrate that simple and broadly available laboratory markers are capable of quantifying a patient’s volume status at the time of stroke and to explore the relationship between volume status and stroke outcomes using tools adapted for use in local Zambian languages. We will additionally conduct focus group interviews with physicians to understand perspectives and current practices in Zambia. Stroke patients from a single hospital in Zambia will have baseline lab testing to assess for dehydration and quantification of stroke severity and functional outcomes over thirty days. We anticipate that the study will establish the clinical relevance of a surrogate composite of labs to identify dehydration in the early stroke period and explore the connection to stroke outcomes in this population. If dehydration is associated with worsened outcomes after stroke, this research will provide the foundation for implementation of a scalable rehydration intervention in future clinical trials. The long-term goal of this study team is to identify potential interventions to improve morbidity and mortality after stroke that are applicable in both resource-rich and resource-limited settings. This research will provide critical data about dehydration and stroke in sub-Saharan Africa, help establish a sustainable system for clinical research and stroke care in Zambia, and inform a future international trial of rehydration after stroke. Given the high stroke rates and projections that stroke burden in sub-Saharan Africa will continue to substantially increase in coming years, interventions are urgently needed to improve patient outcomes in these countries. Such an intervention should be scalable and feasible to administer in non-tertiary settings, with minimal resources, and by non-physician healthcare workers. Emerging evidence indicates that early rehydration after stroke could be such an intervention.