A unique pattern of stroke unit care in Suzhou

曹勇军

www.优德88.cpm 附属第二医院

Background: Stroke is the second cause of death in China , of which 60-80% is acute ischemic stroke. Stroke unit (SU) care is the only treatment option for acute stroke with proven reduction of death and long-term dependency, and the majority of stroke patients benefit from this intervention. Stroke units can be categorized into three types: acute stroke unit, rehabilitation stroke unit and comprehensive stroke unit. There has been establishment of typical and effective stroke units in large hospitals in China . However, it may be inappropriate for middle-sized hospitals to implement such pattern of stroke unit care in our country. The second affiliated hospital of Soochow University has explored a unique pattern of stroke unit care for middle-sized hospitals in China .

Methods: The second affiliated hospital of Soochow University built a unique pattern of stroke unit care of a integrated green channel connecting emergency and a stroke ward, which focuses on the combination of acute treatment and standard secondary prevention for ischemic stroke. The stroke unit possesses specially trained staff and a stroke ward with standard documents such as handbooks and clinical routes and processes. There is a integral system for emergency treatment of cerebrovascular diseases. Patients registering in the emergency room of our hospital will finish demanding tests and examinations as soon as possible through the green channel, which allows screening patients fitting for thrombolysis and giving them the corresponding treatment in the shortest time. We emphasize the standard treatment for ischemic stroke. The examinations for evaluation of cerebral vessels such as Carotid ultrasonography , transcranial Doppler, MRA and CTA can be done within 96 hours after admission, which supply us with information for analysis of ischemic stroke causes and pathogenesis also for individual and stratified treatment. DSA and stent angioplasty can also be done for selected patients. We give patients lessons for rehabilitation and secondary prevention , register their information and follow them up to set up a database of ischemic stroke patients in Suzhou and improve their compliance. There is also a qualified psychological assessment room to screen patients with depression tendency then treat them. Rehabilitation is performed when patients are in stable condition. Since the establishment of the stroke unit, 49 ischemic stroke patients received DSA examinations, 40.8% of the total admitted cases. Compared with a general neurology ward, thrombolysis rate increased(15.67% vs 0.58%, p<0.01). More patients were given statin drugs (91.67% vs 41.86%, p<0.01) and higher dose of atorvastatin was given to patients(21.67±5.97mg vs 19.44±2.36mg, p<0.05). Average first dose of aspirin for patients rised(155.32±90.43mg vs 94.19±19.55mg，p<0.01) and average length of stay for patients was shorter(8.40±4.12d vs 10.91±8.36d, p<0.01).

Conclusion: More standard treatments and shorter length of stay has been observed in this unique pattern of stroke unit care which deserves promotion in middle-sized hospitals in China .