Ováry C, Szegedi N, May Z, Gubucz I, Nagy Z
National Stroke Center, National Institute of Psychiatry and Neurology, Budapest, Hungary.
Eur J Neurol. 2007 Jul;14(7):757-61. doi: 10.1111/j.1468-1331.2007.01775.x.
Although previous studies have proved that both stroke wards and mobile stroke teams are considerably better than non-specialized stroke care, an unresolved debate in vascular neurology is whether or not stroke wards provide better outcomes in some specific cases to stroke victims. Our prospective, multicenter, cohort study compared dedicated stroke wards versus specialist stroke team care at general hospital wards in 11 centers nationwide for 8743 consecutive stroke events during 18 months. Twenty-eight-day case-fatality rate was 12.6% at stroke wards versus 15.2% at stroke teams for all patients (P = 0.002), and stroke ward care also predicted better outcome when analyzed with multivariate logistic regression model (odds ratio 1.701; confidence interval: 1.025-2.822). Case-fatality rates were not significantly different in patients with modified Rankin score > or = 2 (case-fatality rate: 17.8% vs. 20.3%; P = 0.163), and over 60 (case-fatality rate: 14.8% vs. 15.9%; P = 0.250), however these patients were more probably at home after 4 weeks when treated at stroke wards (56.1% vs. 50.6%; P = 0.03, and 69.5% vs. 64.5%; P = 0.004). In our study, stroke ward admission provided lower case-fatality rate below 60 and for those independent prior to their strokes, and lower institutionalization over 60 and amongst previously dependent patients, when compared with stroke teams.
尽管先前的研究已经证明，卒中病房和移动卒中团队都比非专业化的卒中护理要好得多，但在血管神经病学领域，一个尚未解决的争论是，卒中病房在某些特定情况下是否能为卒中患者带来更好的治疗结果。我们的前瞻性、多中心队列研究，在全国11个中心的综合医院病房中，对专门的卒中病房与专科卒中团队护理进行了比较，研究为期18个月，连续纳入了8743例卒中事件。所有患者中，卒中病房的28天病死率为12.6%，而卒中团队为15.2%（P = 0.002），并且在使用多变量逻辑回归模型分析时，卒中病房护理也预示着更好的治疗结果（优势比1.701；置信区间：1.025 - 2.822）。改良Rankin评分>或=2的患者（病死率：17.8%对20.3%；P = 0.163）以及60岁以上患者（病死率：14.8%对15.9%；P = 0.250）的病死率无显著差异，然而，这些患者在卒中病房接受治疗4周后更有可能在家中（56.1%对50.6%；P = 0.03，以及69.5%对64.5%；P = 0.004）。在我们的研究中，与卒中团队相比，卒中病房收治的60岁以下且卒中前独立的患者病死率更低，60岁以上以及先前依赖他人的患者机构化程度更低。
