农村地区基于社区的脑卒中医疗服务体系。
Community-based stroke system of care for Chinese rural areas.
机构信息
From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); State Key Laboratory of Cardiovascular Disease, Sino-German Laboratory for Molecular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
出版信息
Stroke. 2014 Aug;45(8):2385-90. doi: 10.1161/STROKEAHA.114.006030. Epub 2014 Jul 8.
BACKGROUND AND PURPOSE
Stroke system of care plays key roles both in providing effective therapies and in improving the overall outcome of patients with stroke. Our purpose was to develop and evaluate the system in Chinese rural areas.
METHODS
A stroke system of care was developed from November 2009 to November 2010 in 3 townships in Ganyu County. An additional 3 matched townships were invited as controls. We first investigated stroke management in these townships and then implemented stroke system of care and an education campaign in the 3 intervention townships. The effectiveness of the system was then evaluated.
RESULTS
There were 1036 patients with new stroke among 344 345 subjects in the 6 rural communities. The incidence of stroke in the rural areas was 301/100 000, and the mortality rate was 55/100 000. The proportions significantly increased in the intervention communities after the implementation of the stroke system of care and education campaign when compared with the control communities, including patients presenting at rural hospitals within 3 hours of symptom onset (13.6% versus 8.7%; P=0.017), diagnosed by computed tomographic scanning within 24 hours of admission (65.3% versus 58.5%; P=0.034), and received thrombolytic treatment (3.9% versus 1.7%; P=0.038). During the 1-year follow-up, 32 (6.5%) patients with stroke in the intervention communities and 48 (10.1%) in the control communities died. The disability rate of stroke was significantly reduced in the intervention communities at postintervention (38.4% versus 48.1%; P=0.001).
CONCLUSIONS
A stroke system of care would be reliable and practical in Chinese rural areas.
CLINICAL TRIAL REGISTRATION URL
http://www.chictr.org. Unique identifier: ChiCTR-RCH-13003408.
背景与目的
脑卒中医疗体系在为患者提供有效治疗和改善整体预后方面发挥着关键作用。我们的目的是在中国农村地区开发和评估该体系。
方法
2009 年 11 月至 2010 年 11 月，在赣榆县的 3 个乡镇开发了脑卒中医疗体系。另外 3 个匹配的乡镇被邀请作为对照。我们首先调查了这些乡镇的脑卒中管理情况，然后在 3 个干预乡镇实施了脑卒中医疗体系和教育活动。随后评估了该体系的效果。
结果
在 6 个农村社区的 344345 名研究对象中，共有 1036 名新发脑卒中患者。农村地区的脑卒中发病率为 301/100000，死亡率为 55/100000。在实施脑卒中医疗体系和教育活动后，干预社区的脑卒中发病率和死亡率显著高于对照组，包括症状发作后 3 小时内到农村医院就诊的患者比例（13.6%比 8.7%；P=0.017）、发病 24 小时内接受 CT 扫描诊断的患者比例（65.3%比 58.5%；P=0.034）和接受溶栓治疗的患者比例（3.9%比 1.7%；P=0.038）。在 1 年随访期间，干预社区有 32（6.5%）例脑卒中患者死亡，对照组有 48（10.1%）例死亡。干预后，干预社区的脑卒中残疾率显著降低（38.4%比 48.1%；P=0.001）。
结论
脑卒中医疗体系在中国农村地区是可靠且实用的。
临床试验注册网址
http://www.chictr.org. 唯一标识符：ChiCTR-RCH-13003408。
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