López Fernández J C, Masjuan Vallejo J, Arenillas Lara J, Blanco González M, Botia Paniagua E, Casado Naranjo I, Deyá Arbona E, Escribano Soriano B, Freijo Guerrero M M, Fuentes B, Gállego Cullere J, Geffners Sclarskyi D, Gil Núñez A, Gómez Escalonilla C, Lago Martin A, Legarda Ramírez I, Maciñeiras Montero J L, Maestre Moreno J, Moniche Álvarez F, Muñoz Arrondo R, Purroy García F, Ramírez Moreno J M, Rebollo Álvarez Amandix M, Roquer J, Rubio Borrego F, Segura T, Serrano Ponza M, Tejada García J, Tejero Juste C, Vidal Sánchez J A
Servicio de Neurología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España.
Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
Neurologia. 2014 Sep;29(7):387-96. doi: 10.1016/j.nrl.2013.06.017. Epub 2013 Sep 10.
The Spanish Health System's stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets.
The survey on available resources was conducted by a committee of neurologists representing each of Spain's regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24h/7d, nurse ratio, protocols), SU bed ratio/100,000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing iv thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability.
We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74,000 to 1/1,037,000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3,237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3 to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24h/7 d basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine.
Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and irregular in other hospitals. Regional governments should strive to ensure better care and territorial equality, which would achieve the EISNS objectives.
西班牙卫生系统的中风护理策略（EISNS）是一份由各政府机构和科学协会共同起草的共识声明，旨在提高整个护理过程的质量并确保各地区之间的平等。我们的目标是分析现有的医疗资源，并确定它们是否达到了EISNS的目标。
关于可用资源的调查由代表西班牙各地区的神经科医生委员会进行；该委员会还进行了2008年的调查。调查项目包括中风单元（SU）的数量、其资源（监测、每周7天、每天24小时随叫随到的神经科医生、护士比例、协议）、SU床位比例/每10万居民、诊断资源（心脏和脑动脉超声、先进的神经影像学）、静脉溶栓治疗的开展情况、神经血管介入放射学（神经VIR）、恶性大脑中动脉（MCA）梗死的手术治疗以及远程医疗的可用性。
我们纳入了136家医院的数据，发现45个中风单元在各地区分布不均。SU床位与居民的比例从1/74,000到1/1,037,000居民不等；只有坎塔布里亚和纳瓦拉地区达到了目标。神经科医生在83家医院进行了3237例静脉溶栓治疗；与缺血性中风总数相比，溶栓治疗的比例从0.3%到33.7%不等。没有中风单元的医院显示出不同水平的可用资源。除拉里奥哈外，每个地区都开展了神经VIR，并且只有17个城市提供每周7天、每天24小时的VIR服务。46家医院进行了恶性MCA梗死的手术治疗，5家医院有远程医疗服务。
中风护理在参与医院数量、静脉溶栓和血管内治疗的使用增加以及恶性MCA梗死的手术治疗方面有所改善。中风单元和远程医疗的实施仍然不足。大多数中风单元的诊断资源可用性良好，其他医院则参差不齐。地区政府应努力确保更好的护理和地区平等，以实现EISNS的目标。
