Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.
Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Rama IV Road, Bangkok, 10330, Thailand.
BMC Neurol. 2020 Feb 3;20(1):45. doi: 10.1186/s12883-020-1631-9.
Chulalongkorn Stroke Center is a comprehensive stroke center (CSC) located in Bangkok, Thailand. Our stroke network consists of different levels of spoke hospitals, ranging from community hospitals where thrombolytic treatment is not available, to those capable of onsite thrombolytic therapy. This study aimed to assess the time to treatment and outcomes among acute ischemic stroke patients who received thrombolytic treatment in the Chulalongkorn Stroke Network by 1.) Direct arrival at the CSC (mothership) 2.) Telestroke-assisted thrombolytic treatment with secondary transfer to the CSC (drip-and-ship) 3.) Referral from community hospital to the CSC for thrombolytic treatment (ship-and-drip).
Acute ischemic stroke patients who received thrombolytic treatment during January 2016-December 2017 in the Chulalongkorn Stroke Network were studied. Time to treatment and clinical outcomes were compared among treatment groups.
There were 273 patients in the study including 147, 87, and 39 patients in mothership, drip-and-ship, and ship-and-drip paradigms, respectively. The door-to-needle-time (DTN) and onset-to-needle-time (OTN) times were significantly longest in ship-and-drip group (146.5 ± 62/205.03 ± 44.88 mins) compared to mothership (38 ± 23/155.2 ± 60.54 mins) and drip-and-ship (63.0 ± 44/166.09 ± 87 mins), P < 0.05. There was no significant difference regarding functional independence defined by modified Rankin Scale (mRS) ≤ 2 at 3 months (P = 0.12), in-hospital mortality (P = 0.37), mortality at 3 months (P = 0.73), and symptomatic intracerebral hemorrhage (P = 0.24) among groups.
Thrombolytic treatment with drip and ship method under teleconsultation is feasible in Thailand. There was no difference of clinical outcome among the 3 treatment paradigms. However, DTN time and OTN time were longest in the ship-and-drip paradigm.
朱拉隆功卒中中心是位于泰国曼谷的综合性卒中中心。我们的卒中网络由不同级别的卫星医院组成，从不能进行溶栓治疗的社区医院到能够进行现场溶栓治疗的医院。本研究旨在评估在朱拉隆功卒中网络中接受溶栓治疗的急性缺血性卒中患者的治疗时间和结局，具体如下：1. 直接到卒中中心（母舰）就诊；2. 远程卒中辅助溶栓治疗，然后转至卒中中心（滴注和转运）；3. 从社区医院转诊至卒中中心接受溶栓治疗（转运和滴注）。
研究纳入了 2016 年 1 月至 2017 年 12 月在朱拉隆功卒中网络中接受溶栓治疗的急性缺血性卒中患者。比较了不同治疗组之间的治疗时间和临床结局。
研究共纳入 273 例患者，其中母舰、滴注和转运组分别有 147、87 和 39 例患者。与母舰（146.5±62/205.03±44.88 分钟）和滴注和转运（63.0±44/166.09±87 分钟）组相比，转运和滴注组的门到针时间（DTN）和发病到针时间（OTN）最长（205.03±44.88 分钟），差异有统计学意义（P<0.05）。3 个月时改良 Rankin 量表（mRS）评分≤2定义的功能独立性（P=0.12）、住院死亡率（P=0.37）、3 个月死亡率（P=0.73）和症状性颅内出血（P=0.24）在 3 组间无显著差异。
在泰国，通过远程咨询进行滴注和转运溶栓治疗是可行的。在这 3 种治疗模式中，临床结局无差异。然而，转运和滴注模式的 DTN 时间和 OTN 时间最长。
