Suwanwela Nijasri Charnnarong, Eusattasak Nattapong, Phanthumchinda Kammant, Piravej Krisna, Locharoenkul Chaichon
Neurological Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Rd, Bangkok 10330, Thailand.
J Med Assoc Thai. 2007 Jun;90(6):1089-96.
The stroke unit has been established as a standard care for stroke. However, it has not been widely established in developing countries due to the lack of understanding and limited resources.
To compare the complications and mortality of stroke patients admitted in the stroke unit and short-term ward with those admitted in the general medical ward.
The authors prospectively collected data of acute stroke patients who were admitted after the set up of the stroke unit and stroke short-term ward in 2003, and compared with the data of those who were admitted in a general medical ward in 2001. All acute stroke patients who presented within seven days of the onset were admitted and those who had final diagnosis of ischemic stroke or transient ischemic attack (TIA) were studied. Patients in the stroke unit were taken care of by a multidisciplinary team approach under clinical guidelines and a care map. The short-term ward is a part of the general medical ward and stroke patients were treated by a multidisciplinary team followed by homecare treatment. The endpoints were mortality rate, neurological and medical complications during admissions, and the mean length of stay.
Seven hundred and ninety-four patients were studied. Three hundred and eighty-seven patients were admitted in 2001 and 407 patients in 2003. Among patients presented 2003, three hundred and one cases were treated in the acute stroke unit whereas 106 were admitted in the short-term ward. There was no difference in stroke risk factors and stroke subtypes between the two groups, except for dyslipidemia and cigarette smoking, which were more prevalent in patients admitted in 2003. Patients in the stroke unit and the short-term ward had significantly less mortality than those in the general medical ward (8.9 and 2.1%). Overall complications in the stroke unit and the short-term ward were 16.8%, compared to 26% of those admitted into the general medical ward. Significantly less brain edema, hemorrhagic infarction, urinary tract infection, pneumonia, and pressure sore were also observed. The length of hospital stay of the patients admitted in 2001 and 2003 was 11.26 and 8.09 days, respectively.
Combination of organized acute stroke unit and short-term ward with early supported discharge reduces the mortality and complications of ischemic stroke patients during admission as well as the length of stay when compared to the general medical ward. The present study reassures that the combination is useful for hospitals in developing countries, which have limited number of beds in their stroke units.
卒中单元已被确立为卒中的标准治疗模式。然而，由于认识不足和资源有限，其在发展中国家尚未得到广泛应用。
比较入住卒中单元和短期病房的卒中患者与入住普通内科病房的卒中患者的并发症及死亡率。
作者前瞻性收集了2003年卒中单元和卒中短期病房设立后收治的急性卒中患者的数据，并与2001年入住普通内科病房的患者数据进行比较。所有发病7天内就诊的急性卒中患者均被纳入研究，最终诊断为缺血性卒中或短暂性脑缺血发作（TIA）的患者也在研究范围内。卒中单元的患者由多学科团队按照临床指南和护理流程进行照料。短期病房是普通内科病房的一部分，卒中患者由多学科团队治疗，随后接受家庭护理。观察终点为死亡率、住院期间的神经及内科并发症以及平均住院时间。
共研究了794例患者。2001年收治387例患者，2003年收治407例患者。在2003年就诊的患者中，301例在急性卒中单元接受治疗，106例入住短期病房。两组患者的卒中危险因素和卒中亚型无差异，但血脂异常和吸烟在2003年收治的患者中更为常见。卒中单元和短期病房的患者死亡率显著低于普通内科病房的患者（分别为8.9%和2.1%）。卒中单元和短期病房的总体并发症发生率为16.8%，而入住普通内科病房的患者为26%。脑水肿、出血性梗死、尿路感染、肺炎和压疮的发生率也显著较低。2001年和2003年收治患者的住院时间分别为11.26天和8.09天。
与普通内科病房相比，有组织的急性卒中单元和短期病房相结合并早期支持出院，可降低缺血性卒中患者住院期间的死亡率和并发症，以及缩短住院时间。本研究证实，这种组合模式对卒中单元床位有限的发展中国家医院是有用的。
