Minematsu Kazuo
Rinsho Shinkeigaku. 2003 Nov;43(11):796-8.
Therapeutic nihilism has been overcome by the results of phase III trials of intravenous t-PA with 3-hours time window. The integrated team approach can increase the number of patients treated rapidly, permit closer monitoring of patients, potentially increase the safety of thrombolysis, and streamline diagnosis and therapy. The results of randomized clinical trials and meta-analyses demonstrated that stroke unit treatment made mortality lower, hospitalization shorter, good outcome and discharge to the home greater as compared to treatment in general medical units. In a nation-wide survey in Japan, only 3% of hospitals had a stroke care unit, a specialized unit for acute stroke patients. In-hospital mortality was significantly lower in SCU than in ICU or general medical wards. In patients with moderate to severe neurological deficits at admission (NIHSS score 7 or more), good outcome (mRS score 0 to 2) was also more frequently observed in SCU than in other wards. We have to reestablish the systems of acute stroke management. It will be achieved by obtaining the approval of the use of t-PA, organizing stroke care units in major hospitals, and assessing their effects not only on patients' outcome but also on the quality and costs of care by their families, medical personnels and our public societies.
静脉注射组织型纤溶酶原激活剂（t-PA）的III期试验结果在3小时时间窗内克服了治疗虚无主义。综合团队方法可以增加快速接受治疗的患者数量，对患者进行更密切的监测，潜在地提高溶栓的安全性，并简化诊断和治疗流程。随机临床试验和荟萃分析的结果表明，与普通内科病房治疗相比，卒中单元治疗可降低死亡率，缩短住院时间，提高良好预后率和出院回家率。在日本的一项全国性调查中，只有3%的医院设有卒中护理单元，这是一个专门针对急性卒中患者的单元。卒中护理单元（SCU）的院内死亡率显著低于重症监护病房（ICU）或普通内科病房。在入院时具有中度至重度神经功能缺损（美国国立卫生研究院卒中量表[NIHSS]评分7分或更高）的患者中，卒中护理单元比其他病房更频繁地观察到良好预后（改良Rankin量表[mRS]评分0至2分）。我们必须重新建立急性卒中管理系统。这将通过获得t-PA使用的批准、在主要医院组建卒中护理单元以及评估其对患者预后以及对患者家庭、医务人员和我们的社会所提供护理的质量和成本的影响来实现。
