Kitzrow M, Bartig D, Krogias C, Müller-Barna P, Postert T, Sorgenfrei H-U, Weber R, Eyding J
Neurologische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Deutschland,
Nervenarzt. 2013 Dec;84(12):1486-96. doi: 10.1007/s00115-013-3930-5.
The long-term prognosis of stroke patients is still dependent in particular on the timing of a correct diagnosis, immediate initiation of a suitable specific therapy and competent treatment in a stroke unit. Therefore, nationwide attempts are being made to establish a comprehensive coverage of the necessary specific competence and infrastructural requirements. Divergent regional circumstances and economic viewpoints determine the characteristics of the various healthcare concepts and the interplay between participating cooperation partners. This article compares the development with respect to three qualitative treatment parameters exemplified by four regional healthcare models during the time period 2008-2011.
The hospitalization rates for patients with transitory ischemic attacks, ischemic and hemorrhagic stroke, the case numbers for stoke unit treatment and the rates of systemic thrombolysis and mechanical thrombectomy in the regions of Berlin, the Ruhr Area, Ostwestfalen-Lippe and southeast Bayern (TEMPiS) are presented based on the data from the DRG statistical reports for the years 2008 and 2011.
The average hospitalization rates for ischemic stroke patients (brain infarct ICD 163) in the time period from 2008 to 2011 were 294 per 100,000 inhabitants for the Ruhr Area, 257 per 100,000 inhabitants for Ostwestfalen-Lippe and 265 per 100,000 inhabitants each for Berlin and southeast Bayern. The complex stroke treatment quota for southeast Bayern in 2008 was 31 % and 47 % in 2011 and the respective quotas for the other regions studied were 42-44 % and 58-59 %. The rate of systemic thrombolysis in 2008 ranged between 4.2 % and 7.4 % and in 2011 the increase in the range for the 4 regions studied was between 41 % and 145 %. In 2011 the thrombectomy quota of 2 % in the Ruhr Area was the only one which was above the national average of 1.3 % of all brain infarcts.
Stroke is a common disease in the four regions studied. For the established forms of therapy, complex treatment of stroke and systemic thrombolysis, the positive effect of structurally improved approaches in the four different regional treatment concepts could be confirmed during the course of the observational time period selected. Mechanical thrombectomy which is currently still considered to be an individual healing attempt, was used significantly more often in the Ruhr Area in 2011 than in the other three regions studied. A standardized referral procedure had previously been established in the metropolitan regions.
中风患者的长期预后尤其取决于正确诊断的时机、及时启动合适的特异性治疗以及在中风单元进行专业治疗。因此，正在全国范围内努力全面满足必要的专业能力和基础设施要求。不同的地区情况和经济观点决定了各种医疗保健概念的特点以及参与合作伙伴之间的相互作用。本文比较了2008 - 2011年期间以四种区域医疗保健模式为例的三个定性治疗参数的发展情况。
根据2008年和2011年疾病诊断相关分组（DRG）统计报告的数据，列出了柏林、鲁尔区、东威斯特法伦 - 利珀和巴伐利亚东南部（TEMPiS）地区短暂性脑缺血发作、缺血性和出血性中风患者的住院率、中风单元治疗的病例数以及全身溶栓和机械取栓率。
2008年至2011年期间，鲁尔区缺血性中风患者（脑梗死ICD 163）的平均住院率为每10万居民294例，东威斯特法伦 - 利珀为每10万居民257例，柏林和巴伐利亚东南部均为每10万居民265例。巴伐利亚东南部2008年的复杂中风治疗配额为31%，2011年为47%，其他研究地区的相应配额为42 - 44%和58 - 59%。2008年全身溶栓率在4.2%至7.4%之间，2011年，所研究的4个地区的增幅在41%至145%之间。2011年，鲁尔区2%的取栓配额是唯一高于全国所有脑梗死1.3%平均水平的。
中风在所研究的四个地区都是常见疾病。对于既定的治疗形式、中风的复杂治疗和全身溶栓，在所选观察时间段内，可以证实四种不同区域治疗概念中结构改善方法的积极效果。目前仍被视为个体治疗尝试的机械取栓术，2011年在鲁尔区的使用频率明显高于其他三个研究地区。此前在大都市地区已建立了标准化的转诊程序。
