異なる経済レベルでの各国における脳卒中後の実践パターンと結果 (INTERSTROKE):国際的観察研究
Peter Langhorne1, Martin J O'Donnell2, Siu Lim Chin3
1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Lancet (London, England)
|June 5, 2018
まとめ
低所得国では 脳卒中治療がほとんど行われていませんが 脳卒中治療と抗血小板治療の利用は 患者の生存率と回復率を向上させています これらの地域の施設の改善は 脳卒中の改善に不可欠です
科学分野:
- 世界保健
- 神経科学
- 医療サービス研究
背景:
- 低所得国や中所得国 (LMICs) は脳卒中により不均衡な影響を受けている.
- 高所得国 (HIC) と比較すると,LMICにおける脳卒中治療の実践と結果に関するデータは限られている.
研究 の 目的:
- 異なる経済水準の国々における 患者の治療結果との関連を比較する
- 国民所得に関係なく,脳卒中の回復に影響を与える要因を特定する.
主な方法:
- 国際的なINTERSTROKE研究 (13,447人の患者,142の施設,32カ国) のデータの分析.
- 病院のアンケートに 患者データを追加しました
- サービス,治療,患者1ヶ月のアウトカム (死亡または依存) の関連性を評価するために,リグレッション分析を使用した.
主要な成果:
- LMIC患者には,HIC患者よりも重度の脳卒中,脳内出血,サービスへのアクセスが悪く,検査/治療が少ない.
- 脳卒中ユニットへのアクセスにより,調査/治療の利用,リハビリテーションへのアクセス,重度の依存症のない生存が改善されました (OR1.29).
- 急性抗血小板治療の使用は,他の要因とは独立して,生存率の改善と関連していました (OR1. 39).
結論:
- 証拠に基づいた脳卒中治療,診断,および脳卒中ユニットはLMICではあまり普及していません.
- 脳卒中ユニットへのアクセスと適切な抗血小板剤の使用は,患者のよりよい回復と相関しています.
- LMICの脳卒中治療施設とアクセスを改善することは 患者の成果を向上させるために不可欠です
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