Liječenje bolesnika s prolaznim ishemijskim napadajima u Kliničkom bolničkom centru 'Sestre milosrdnice'

Autor: Arijana Lovrenčić-Huzjan, Maja Strineka, Darja Šodec-Šimičević, Dražen Ažman, Sanja Štrbe, Vlasta Vuković-Cvetković, Irena Martinić-Popović, Vida Demarin
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Zdroj: Acta clinica Croatica
Volume 50
Issue 3
ISSN: 1333-9451
0353-9466
Popis: Improved outcomes were observed in transient ischemic attack (TIA) patients after implementation of recommendations for stroke management and after multiple interventions such as public campaigns focused on raising awareness of stroke and reorganization of health services. The aim of this study was to describe reorganization of in-hospital services to improve the management of patients suspected of having TIA or stroke, and to validate these measures with patient outcomes. Data on 5219 patients examined between January 1 and December 31, 2008 at emergency neurology outpatient department were analyzed. Patients were referred by general practitioners, emergency physicians, or were brought by relatives without being previously seen by health services staff. The emergency services department is intended to improve care for TIA patients, providing a short standardized clinical assessment followed by initiation of a comprehensive stroke prevention program. Demographic data, risk factors, stroke type, previous TIA history, ABCD2 scores and admission rates were analyzed. A total of 1057 patients suspected of having stroke or TIA were examined. There were 447 patients with ischemic stroke (mean age 73+11 years, 196 males) and 99 patients with TIA (mean age 67+14 years, 55 males). Parenchymal hemorrhage was diagnosed in 56 and subarachnoid hemorrhage in 49 patients, while 406 patients had nonspecific symptoms or other systemic or neurologic diseases. TIA preceded stroke in 29 (6.5%) patients and 197 (44%) patients were examined for worsening of stroke symptoms (133 within 24 hours, 47 within 48 hours, and 17 within 7 days). The mean ABCD2 score was 2.95. In all examined patients, a comprehensive stroke prevention program was started; 427/447 (95%) strokes and 31/99 (31%) TIAs were hospitalized at neurology department. Four (4%) TIA patients developed stroke and were hospitalized, three of them after 2 days (ABCD2 score 3.4 and 5) and one after 7 days (ABCD2 score 5). Preventive measures resulted in a low number of strokes after TIA (
Zamijećen je poboljšani ishod bolesnika s prolaznim ishemijskim napadajima (TIA) nakon što su primijenjene preporuke za zbrinjavanje moždanog udara te nakon različitih intervencija kao što su bile javne kampanje usmjerene na podizanje svijesti o moždanom udaru i reorganizaciju zdravstvenih usluga. Cilj ovoga istraživanja bio je opisati reorganizaciju bolničke službe za poboljšanje liječenja bolesnika kod kojih se sumnjalo na postojanje moždanog udara ili TIA i provjeriti valjanost ovih mjera na ishodu bolesti. Analizirani su podaci o 5219 bolesnika pregledanih između 1. siječnja i 31. prosinca 2008. u hitnoj neurološkoj ambulanti. Bolesnici su bili upućeni od liječnika opće medicine, liječnika hitne medicinske pomoći ili su dovezeni u pratnji rodbine bez prethodnog pregleda osoblja u zdravstvenoj službi. Hitna neurološka službe je organizirana tako da poboljša skrb za bolesnike s TIA, te da pruži kratku i standardiziranu kliničku procjenu i pokrene sveobuhvatni program prevencije moždanog udara. Analizirani su demografski podaci, čimbenici rizika, tipovi moždanog udara, prethodne epizode TIA, zbroj ABCD2 te stope prijma. Ukupno je pregledano 1057 bolesnika kod kojih se sumnjalo na dijagnozu moždanog udara ili TIA. Bilo je 447 bolesnika s ishemijskim moždanim udarom (srednja dob 73+11 godina, 196 muškaraca), 99 s TIA (srednja dob 67+14 godina, 55 muškaraca). Parenhimatozna krvarenja su dijagnosticirana kod 56, a subarahnoidno krvarenje u 49 bolesnika, dok je 406 bolesnika imalo nespecifične simptome ili druge sistemske i neurološke bolesti. TIA je prethodila moždanom udaru u 29 (6,5%) bolesnika, a 197 (44%) bolesnika je pregledano nakon pogoršanja simptoma povezanih s moždanim udarom (133 u roku od 24 sata, 47 u roku od 48 sati, a 17 u roku od 7 dana). Srednja vrijednost zbroja ABCD2 je bila 2,95. U svih pregledanih bolesnika započet je sveobuhvatni program prevencije moždanog udara, 427/447 (95%) bolesnika s moždanim udarom i 31/99 (31%) bolesnika s TIA je hospitalizirano u našoj Klinici za neurologiju. Četiri bolesnika s TIA su razvili moždani udar (4%) i bili hospitalizirani nakon toga, 3 bolesnika nakon 2 dana (zbroj ABCD2 3,4 i 5), a jedan nakon 7 dana (zbroj ABCD2 5). Preventivne mjere su rezultirale niskim brojem moždanih udara nakon preboljelog TIA (
Databáze: OpenAIRE
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