Rymer Marilyn M, Thrutchley Duane E
Mid America Brain and Stroke Institute, Saint Luke's Hospital, 4401 Wornall Road, Kansas City, MO 64111, USA.
Neurol Res. 2005;27 Suppl 1:S9-16. doi: 10.1179/016164105X25315.
Acute ischemic stroke is the second leading cause of death worldwide and the leading cause of adult disability in the United States (US). Thrombolytic therapy was proved effective, and approved for use, in the US by the Food and Drug Administration in 1996, yet 8 years later just 3-4% of stroke victims in the US are treated with tissue plasminogen activator. In order to understand how this figure can be substantially improved, it is important to evaluate the available therapies and systems of care, delineate the critical steps and the existing barriers in the process for successful intervention, and thoroughly understand the key components in the highly successful interventional stroke programs, especially regionalization of care.
A review of the available literature was carried out and interventional stroke data from the Mid America Brain and Stroke Institute at Saint Luke's Hospital (SLH) in Kansas City, Missouri, was analysed.
There are several treatment strategies available for acute stroke intervention and more are likely to be developed. There is increasing interest in organizing and standardizing care for stroke. The steps in the process for successful intervention are understood and progress is being made in several areas of the country, but challenges remain in public education, directing emergency transport to 'stroke ready' hospitals and linking stroke experts to primary care providers. The Kansas City regional network linking primary care hospitals to the stroke team at SLH has been highly successful in substantially increasing the number of patients receiving acute stroke intervention.
The stage is set for many more stroke victims to receive acute interventional therapy. However, these patients must present to hospitals equipped and staffed to render this therapy. Most stroke victims will go or be taken to the closest medical facility. Organizing regional networks linking primary care hospitals and physicians to comprehensive stroke centers staffed, and capable of providing the entire spectrum of acute stroke intervention will be essential in substantially increasing the number of stroke victims who actually receive acute interventional therapy. This article summarizes the evolving solutions to this challenge with specific data from the successful regional network developed around the Mid America Brain and Stroke Institute at Saint Luke's Hospital in Kansas City, Missouri, USA.
急性缺血性中风是全球第二大致死原因，在美国是成人残疾的主要原因。1996年，溶栓疗法在美国被证明有效并获批准使用，但8年后，美国只有3%至4%的中风患者接受了组织型纤溶酶原激活剂治疗。为了理解如何大幅提高这一数字，评估现有的治疗方法和护理系统、明确成功干预过程中的关键步骤和现有障碍，并深入了解高度成功的中风介入项目中的关键组成部分，尤其是护理的区域化，非常重要。
对现有文献进行了综述，并分析了密苏里州堪萨斯城圣卢克医院（SLH）中美脑卒中和中风研究所的介入性中风数据。
有几种治疗策略可用于急性中风干预，并且可能会开发出更多策略。人们对组织和规范中风护理的兴趣日益浓厚。成功干预过程中的步骤已为人所知，美国一些地区也正在取得进展，但在公众教育、引导紧急运输至“具备中风救治能力”的医院以及将中风专家与初级保健提供者联系起来方面仍存在挑战。将初级保健医院与SLH的中风团队联系起来的堪萨斯城区域网络在大幅增加接受急性中风干预的患者数量方面非常成功。
更多中风患者接受急性介入治疗的阶段已经到来。然而，这些患者必须前往配备有相应设备和人员的医院接受这种治疗。大多数中风患者会前往或被送往最近的医疗机构。组织区域网络，将初级保健医院和医生与配备齐全、能够提供全方位急性中风干预的综合中风中心联系起来，对于大幅增加实际接受急性介入治疗的中风患者数量至关重要。本文用来自美国密苏里州堪萨斯城圣卢克医院中美脑卒中和中风研究所周围成功建立的区域网络的具体数据，总结了应对这一挑战的不断发展的解决方案。
