Department of Neurology, Christian Medical College, Ludhiana, India.
SEARCH, Gadchiroli, India.
Lancet. 2020 Oct 31;396(10260):1443-1451. doi: 10.1016/S0140-6736(20)31374-X.
The burden of stroke is higher in low-income and middle-income countries (LMICs) than in high-income countries and is rising. Even though there are global policies and guidelines for implementing stroke care, there are many challenges in setting up stroke services in LMICs. Despite these challenges, there are many models of stroke care available in LMICs-eg, multidisciplinary team care led by a stroke neurologist, specialist-led care by neurologists, physician-led care, hub and spoke models incorporating stroke telemedicine (ie, telestroke), and task sharing involving community health workers. Alternative strategies have been developed, such as reorganising the existing hospital infrastructure by training health professionals to implement protocol-driven care. The future challenge is to identify what elements of organised stroke care can be implemented to make the largest gain. Simple interventions such as swallowing assessments, bowel and bladder care, mobility assessments, and consistent secondary prevention can prove to be key elements to improving post-discharge morbidity and mortality in LMICs.
中风的负担在低收入和中等收入国家（LMICs）高于高收入国家，并呈上升趋势。尽管有实施中风护理的全球政策和指南，但在 LMICs 中建立中风服务仍存在许多挑战。尽管存在这些挑战，但在 LMICs 中已经有许多中风护理模式可用-例如，由中风神经科医生领导的多学科团队护理，由神经科医生领导的专科护理，由医生领导的护理，结合中风远程医疗（即远程中风）的中心辐射模型，以及涉及社区卫生工作者的任务分担。已经开发了替代策略，例如通过培训卫生专业人员实施基于方案的护理来重组现有医院基础设施。未来的挑战是确定可以实施哪些有组织的中风护理要素以获得最大收益。简单的干预措施，如吞咽评估、肠道和膀胱护理、活动能力评估以及一致的二级预防，可以证明是改善 LMICs 出院后发病率和死亡率的关键要素。
