University of South Carolina, School of Medicine, Greenville, SC, USA.
University of South Carolina, School of Medicine, Greenville, SC, USA.
Arch Med Res. 2018 Nov;49(8):588-597. doi: 10.1016/j.arcmed.2019.01.002. Epub 2019 Jan 14.
The benefits of a special stroke care unit (SSCU) over a non-specialized stroke care unit (NSSCU) is well documented in the literature. However, there are concerns that the benefits seen in the SSCU do not consider clinical risk factors that affect thrombolysis therapy.
Retrospective data were collected from a stroke registry between January 1, 2010-June 30, 2016. Univariate analysis determined differences in exclusion criteria between the SSCU and NSSCU, while multivariable binary logistic regression adjusted for confounding variables.
Of the 1,446 acute ischemic stroke patients eligible for rtPA, 34.0% of patients were admitted to the NSSCU, while 58.02% were admitted to the SSCU. For patients excluded from receiving rtPA in the SSCU: age >80 (OR = 1.024-1.037, p = <0.001), altered level of consciousness (OR = 1.551-2.363, p = 0.041), risk of mortality (OR = 1.090-1.166, p = 0.012), previous stroke (OR = 1.638-2.338, p = 0.007) were the exclusion criteria from rtPA. In the NSSCU, age >80 (OR = 1.026-1.046, p = 0.012), history of atrial fibrillation (OR = 2.494-4.629, p = 0.004), diabetes (OR = 2.377-5.576, p = 0.047) and previous stroke (OR = 2.782-4.785, p = <0.001) were associated with exclusion from rtPA.
More patients are likely to be excluded from rtPA in the NSSCU if they present with history of atrial fibrillation, diabetes, and in the SSCU if they present with altered level of consciousness and are at risk of mortality. Improvement in the management of baseline clinical risk factors would improve thrombolysis use for better patient outcomes in specialized and non specialized stroke units.
文献中充分证明了特殊卒中护理单元（SSCU）比非专业卒中护理单元（NSSCU）更具优势。然而，人们担心 SSCU 中观察到的益处并未考虑影响溶栓治疗的临床风险因素。
从 2010 年 1 月 1 日至 2016 年 6 月 30 日的卒中登记处收集回顾性数据。单变量分析确定了 SSCU 和 NSSCU 之间排除标准的差异，而多变量二元逻辑回归调整了混杂变量。
在 1446 名适合接受 rtPA 的急性缺血性卒中患者中，34.0%的患者被收入 NSSCU，而 58.02%的患者被收入 SSCU。在 SSCU 中被排除接受 rtPA 的患者中：年龄>80（OR=1.024-1.037，p<0.001）、意识水平改变（OR=1.551-2.363，p=0.041）、死亡率风险（OR=1.090-1.166，p=0.012）、既往卒中（OR=1.638-2.338，p=0.007）是排除 rtPA 的标准。在 NSSCU 中，年龄>80（OR=1.026-1.046，p=0.012）、心房颤动史（OR=2.494-4.629，p=0.004）、糖尿病（OR=2.377-5.576，p=0.047）和既往卒中（OR=2.782-4.785，p<0.001）与排除 rtPA 相关。
如果患者有心房颤动史、糖尿病史，则更有可能在 NSSCU 中被排除接受 rtPA 治疗，如果患者意识水平改变且有死亡风险，则更有可能在 SSCU 中被排除接受 rtPA 治疗。改善基线临床风险因素的管理将改善溶栓治疗的使用，从而改善专业和非专业卒中病房患者的预后。
