Hospital-based prospective registration of acute ischemic stroke and transient ischemic attack in Japan.
Hospital-based prospective registration of acute ischemic stroke and transient ischemic attack in Japan.
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DOI：
10.1016/j.jstrokecerebrovasdis.2003.11.025
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发表时间：
2004-01-01
期刊：
影响因子：
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通讯作者：
Yamaguchi, Takenori
中科院分区：
文献类型：
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作者：
Kimura, Kazumi;Kazui, Seiji;Yamaguchi, Takenori
本研究的目的是获得日本急性缺血性卒中和短暂性脑缺血发作（TIA）患者的基本信息。我们前瞻性登记了1999年5月1日至2000年4月30日期间在发病后7天内访问156家参与医院的连续卒中和TIA患者。共有16，922例患者入组本研究，年龄为70.6 ± 11.5岁（中位数71，范围18-107）。TIA见于7%的登记患者，腔隙性卒中36%，动脉粥样硬化血栓形成31%，心源性栓塞性卒中20%，其他6%。高血压占61%，糖尿病占24%，房颤占21%，吸烟占18%，高胆固醇血症占17%。总体而言，37%的患者在症状发作后3小时内到达医院，50%在6小时内到达医院。在6小时内前往医院的人中，64%使用救护车服务。平均NIHSS评分为8.0 ± 7.9（中位数，5）。仅3%的患者在急性期接受溶栓治疗。只有19%的患者在卒中监护室或重症监护室接受治疗。出院时改良兰金量表评分0 ~ 2分者占61%，3 ~ 5分者占32%，死亡率为7%。超过一半的急性中风患者在发病6小时后到达医院，中风监护病房只在所有患者的五分之一中使用。建立理想的急诊系统和卒中单元的安排也有待于更好的管理和改善患者的预后。
The purpose of this study was to obtain fundamental information on patients with acute ischemic stroke and transient ischemic attack (TIA) in Japan. We prospectively registered consecutive stroke and TIA patients who visited 156 participating hospitals within 7 days of onset between May 1, 1999 and April 30, 2000. A total of 16,922 patients with 70.6 +/- 11.5 years old (median 71, range 18-107) were enrolled in the study. TIA was seen in 7% of registered patients, lacunar stroke in 36%, atherothrombotic in 31%, cardioembolic stroke in 20%, and other in 6%. Hypertension was present in 61%, diabetes mellitus in 24%, atrial fibrillation (AF) in 21%, smoking in 18%, and hypercholesterolemia in 17%. Overall, 37% of patients arrived at hospital within 3 hours of symptom onset, and 50% within 6 hours. Among those who visited the hospital within 6 hours, 64% used an ambulance service. Mean NIHSS score was 8.0 +/- 7.9 (median, 5). Only 3% were treated with thrombolytic agents in acute phase of stroke. Only 19% of all patients were treated in stroke care unit or intensive care unit. The modified Rankin Scale score of 0 to 2 at discharge was observed in 61% of the patients, 3 to 5 in 32%, and the mortality rate was 7%. More than half of the acute stroke patients arrived at the hospital after 6 hours of onset, and the stroke care unit was used only in one fifth of all patients. Establishment of ideal emergency system and arrangement of stroke units are also awaited for better management and improvement of patients' outcome.