Hiu Takeshi, Ozono Keisuke, Kawahara Ichiro, Yamasaki Kazumi, Satoh Kei, Otsuka Hiroaki, Nakamichi Chikaaki, Iwanaga Hiroshi, Fukuda Yutaka, Honda Kazuya, Hiu Hiroyuki, Ono Tomonori, Haraguchi Wataru, Ushijima Ryujiro, Tsutsumi Keisuke
Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
Clinical Research Center, National Hospital Organization Nagasaki Medical Center.
Neurol Med Chir (Tokyo). 2019 Dec 15;59(12):504-510. doi: 10.2176/nmc.oa.2019-0111. Epub 2019 Nov 21.
Our hospital, located on the mainland, serves as a hub center for nine hospitals on the remote islands of Nagasaki Prefecture, Japan. There are no stroke specialists on these islands. We can transfer emergency patients from these islands to our hospital at any time, using a teleradiology system and three types of helicopter transport. We examined the efficacy of the drip and ship (DS) method for treating patients with acute ischemic stroke (AIS) on these islands, in comparison with patients on the mainland. From 2010 to 2017, we reviewed 98 consecutive patients with AIS who received intravenous recombinant tissue plasminogen activator (IV rt-PA) in our hospital or were transported to our hospital after IV rt-PA. Patients were divided into the Islands group (received IV rt-PA on the islands, DS; 31 cases) and the Mainland group (67 cases). The median transport distance from the islands was 112 km. The rate of patients achieving favorable outcomes was 54.8% in the Islands group and 64.2% in the Mainland group, with no significant differences. Multivariate analysis revealed that patients living on isolated islands did not have increased risks of unfavorable outcomes. Endovascular therapy (EVT), as part of the drip, ship, and retrieve method, was performed in 22.6% of patients in the Islands group and EVT in 38.8% of those in the Mainland group. The DS method seems feasible and safe for patients living on isolated islands with the use of 24-h helicopter transportation and teleradiology.
我们医院位于日本长崎县偏远岛屿的九家医院的枢纽中心。这些岛屿上没有中风专家。我们可以使用远程放射学系统和三种直升机运输方式，随时将这些岛屿上的急诊患者转运到我们医院。我们比较了在这些岛屿上使用滴注与转运（DS）方法治疗急性缺血性中风（AIS）患者与大陆患者的疗效。2010年至2017年，我们回顾了98例在我院接受静脉注射重组组织型纤溶酶原激活剂（IV rt-PA）或在IV rt-PA治疗后被转运至我院的连续AIS患者。患者分为岛屿组（在岛屿上接受IV rt-PA治疗，采用DS方法；31例）和大陆组（67例）。从岛屿转运的中位距离为112公里。岛屿组获得良好预后的患者比例为54.8%，大陆组为64.2%，无显著差异。多变量分析显示，居住在偏远岛屿上的患者出现不良预后的风险并未增加。作为滴注、转运和取回方法的一部分，岛屿组22.6%的患者接受了血管内治疗（EVT），大陆组38.8%的患者接受了EVT。对于居住在偏远岛屿上的患者，使用24小时直升机运输和远程放射学，DS方法似乎是可行和安全的。
