Division of Health and Social Care Research, King's College London, London, United Kingdom.
PLoS One. 2013 Apr 25;8(4):e61581. doi: 10.1371/journal.pone.0061581. Print 2013.
Studies examining the impact of organised acute stroke care interventions on survival in subgroups of stroke patients remain limited.
This study examined the effects of a range of evidence-based interventions of acute stroke care on one year survival post-stroke and determined the size of the effect across different socio-demographic and clinical subgroups of patients.
Data on 4026 patients with a first-ever stroke recruited to the population-based South London Stroke Register between 1995 and 2010 were used. In uni-variable analyses, one year cumulative survival rates in socio-demographic groups and by care received was determined. Survival functions were compared using Log-rank tests. Multivariable Cox models were used to test for interactions between components of care and age group, sex, ethnic group, social class, stroke subtype and level of consciousness.
1949 (56.4%) patients were admitted to a stroke unit. Patients managed on a stroke unit, those with deficits receiving specific rehabilitation therapies and those with ischaemic stroke subtype receiving aspirin in the acute phase had better one year survival compared to those who did not receive these interventions. The greatest reduction in the hazards of death among patients treated on a stroke unit were in the youngest patients aged <65 years, (HR 0.39; 95% CI: 0.25-0.62), and those with reduced levels of consciousness, GCS <9, (HR: 0.44; CI: 0.33-0.58).
There was evidence of better one year survival in patients receiving specific acute interventions after stroke with a significantly greater effect in stroke subgroups, suggesting the possibility of re-organising stroke services to ensure that the most appropriate care is made accessible to patients likely to derive the most benefits from such interventions.
研究急性卒中护理干预对卒中患者亚组生存影响的研究仍然有限。
本研究检测了一系列急性卒中护理的循证干预措施对卒中后 1 年生存的影响，并确定了不同社会人口学和临床亚组患者的影响大小。
使用 1995 年至 2010 年在人群为基础的伦敦南部卒中登记处登记的 4026 例首次卒中患者的数据。在单变量分析中，确定了社会人口学组和接受护理的患者的 1 年累积生存率。使用对数秩检验比较生存函数。使用多变量 Cox 模型检验护理成分与年龄组、性别、种族、社会阶层、卒中亚型和意识水平之间的交互作用。
1949 例（56.4%）患者被收入卒中单元。在卒中单元管理的患者、有残疾接受特定康复治疗的患者和在急性期接受阿司匹林治疗的缺血性卒中亚型患者的 1 年生存率优于未接受这些干预的患者。在卒中单元治疗的患者中，死亡风险降低幅度最大的是年龄<65 岁的最年轻患者（HR 0.39；95%CI：0.25-0.62）和意识水平降低的患者，GCS<9（HR：0.44；CI：0.33-0.58）。
接受特定急性干预的患者有更好的 1 年生存率，卒中亚组的效果更为显著，这表明有可能重新组织卒中服务，以确保最适当的护理能够提供给最有可能从这些干预中获益的患者。
