Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, India.
Neuroepidemiology. 2017;49(1-2):45-61. doi: 10.1159/000479518. Epub 2017 Aug 19.
The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services.
To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care.
A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included.
We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible.
In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.
中低收入国家（LMICs）的中风负担很大且在不断增加，这给本已紧张的医疗服务带来了挑战。
确定中低收入国家现有的中风护理服务质量，并强调在中风护理中使用的本土、廉价、基于证据且可实施的策略。
使用 PubMed 和 Google Scholar 从 1966 年 1 月到 2015 年 10 月进行了详细的文献搜索，使用了一系列搜索词。在 921 篇出版物中，有 373 篇被筛选出来，有 31 篇关于现有中风服务的文章被包括在内。
我们确定了高效的救护车运输和预先通知模型。一些国家设有中风单元（SU），但相对较少，主要由私营部门提供。很少有患者接受溶栓治疗；这可以通过远程医疗和政府补贴来增加。二级预防药物的依从性受到可用性和可负担性有限的影响，强调了初级预防的重要性。对中风后护理的护理人员、照顾者和护士进行培训是可行的。
在这项系统评价中，我们发现了一些关于中低收入国家基于证据的可实施中风服务的报告。一些策略是经济、可行和可复制的，但仍未经过测试。关于其结果和可持续性的数据有限。应优先研究实施本地化和区域化适应的中风服务以及具有成本效益的二级预防计划。
