Xử trí trong đơn vị đột quỵ Chăm sóc trong đơn vị đột quỵ: Liệu thể nhồi máu não có đặt thành vấn đề

Chăm sóc trong đơn vị đột quỵ cải thiện sự tiến triển bệnh sau nhồi máu não. Tuy nhiên, người ta không biết liệu tất cả các thể nhồi máu não sẽ thu được lợi ích như nhau hay không khi vào đơn vị đột quỵ. Bài viết trình bày xác định liệu lợi ích thu được từ việc điều trị trong đơn vị đột quỵ có như nhau đối với các thể nhồi máu não.
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Xử trí trong đơn vị đột quỵ Chăm sóc trong đơn vị đột quỵ: Liệu thể nhồi máu não có đặt thành vấn đề Stroke Unit ManagementXử trí trong đơn vị đột quỵChăm sóc trong đơn vị đột quỵ: Liệu thể nhồi máu não cóđặt thành vấn đề?Stroke unit care: does ischemic stroke subtype matter?Gustavo Saposnik1,2,3*, Khalid A. Hassan4, Daniel Selchen1, Jiming Fang2, Moira K. Kapral2,3,5,6, andEric E. Smith7, on behalf of the Investigators of the Registry of the Canadian Stroke Network forthe Stroke Outcome Research Canada(SORCan - www.sorcan.ca) working group Translated by Dr. Trần Viết Lực Revised by Prof. Lê Văn ThínhBackground: Stroke unit care improves outcomes following outcomes were seven-day mortality and death orischemic stroke. However, it is not known whether all institutionalization at discharge.ischemic stroke subtypes benefit equally from stroke unit Results: Among 6223 eligible patients with ischemicadmission. stroke admitted to regional stroke centers in Ontario, theObjective: To determine whether the benefit of stroke unit mean age was 72 years and 52.4% were male. Overalladmission is similar among all ischemic stroke subtypes. 30-day mortality was 12.2%. The 30-day risk-adjusted mortality was lower for stroke unit care across all strokeDesign, setting and patients: Prospective cohort study subtypes (for lacunar stroke 3.0% vs. 5.3%; for largeincluding patients admitted with an acute ischemic artery disease 7.5% vs. 14.5%; for cardioembolic 15.3%stroke between July 2003 and September 2007 to stroke vs. 23.3%; and for other causes 8.9% vs. 15.9%). Incenters participating institutions in the Registry of the multivariable analysis, after controlling for age, gender,Canadian Stroke Network. Ischemic stroke subtype medical comorbidities, and stroke severity, there was ainformation was determined according to the modified significant reduction in stroke mortality associated withTrial of Org 10 172 in Acute Stroke Treatment criteria stroke unit admission in all stroke subtypes (odds ratioand categorized as small vessel disease (lacunar), large (95% confidence interval) for lacunar stroke 0.48 (0.27–artery atherosclerotic disease, cardioembolic, or other 0.88), for large artery atherosclerotic disease 0.39 (0.27–(including both other determined and undetermined 0.56), for cardioembolic 0.46 (0.36–0.59), and for othercauses). causes 0.45 (0.29–0.70)). The results remained similarMain outcome measures: The primary outcome measure after a sensitivity analysis excluding patients receivingwas all-cause mortality at 30 days after stroke. Secondary palliative care, and a secondary analysis including 3215 patients with missing Trial of Org 10 172 in Acute StrokeCorrespondence: Gustavo Saposnik*, 55 Queen St East, Suite Treatment classification.931, St Michael’s Hospital, University of Toronto, Toronto, CanadaM5C 1R6. Conclusion: This study provides ‘real-world’ evidenceEmail: saposnikg@smh.ca that all ischemic stroke subtypes do benefit from a stroke1 Director, Stroke Outcomes Research Unit, Stroke Research Unit, unit admission regardless of the etiology. There is noDepartment of Medicine, Division of Neurology, St. Michael’s justification for withholding access to strokeunit careHospital, University of Toronto, Toronto, Ontario, Canada based on stroke subtype.2 Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada Key words: epidemiology, infarction, mortality, outcome,3 Departments of Medicine and Health Policy, Management and outcome research, stroke, stroke unit.Evaluation, University of Toronto, Toronto, Ontario, Canada4 Department ofMedicine, Division of Neurology, Amiri Hospital,Kuwait City, Kuwait5 Department ofMedicine,Division ofGeneral InternalMedicine andClinical Epidemiology, University Health Network, Toronto, Ontario, Cơ sở: Chăm sóc trong đơn vị đột quỵ cải thiện sự tiến triểnCanada bệnh sau nhồi máu não. Tuy nhiên, người ta không biết liệu6 Women’s Health Program, University Health NetworkWomen’s tất cả các thể nhồi máu não sẽ thu được lợi ích như nhauHealth Program, Toronto, Ontario, Canada hay không khi vào đơn vị đột quỵ.7 Calgary Stroke Program, Department of Clinical Neurosciences,Hotchkiss Brain ...