脳卒中専門医不在地域における脳卒中治療と予後の検討 : 徳島県南部？保険医療圏と徳島大学脳卒中センターとの比較検討

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概要

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• INTRODUCTION:For cranial nerve diseases, particularly stroke, early-stage treatment by stroke specialists cansignificantly alter patient prognosis. With respect to the treatment of acute cerebral infarction, t‐PAwas approved for health insurance coverage in Japan in November２００５, and has greatly influencedmedical practice. However, the use of t‐PA necessitates an expertise in stroke treatment, and thedrug cannot be used in areas where stroke specialists are absent. Consequently, disparities maybe occurring in stroke treatment among different areas. We accordingly aimed to evaluate strokepatients in the south Tokushima Ⅱ medical areas（south Ⅱ medical areas）without stroke specialistsand those transferred to the stroke care unit in the Stroke Center of Tokushima UniversityHospital（Tokushima University Hospital SCU）, and to clarify the presence or absence of disparitiesin area-based stroke treatment in Tokushima.METHODS:The subjects were１０３stroke patients in the south Tokushima Ⅱ medical areas without strokespecialists and ３１７ stroke patients in Tokushima University Hospital SCU, who were assessedbetween October１，２００９and September３０，２０１０.RESULTS:In the areas without stroke specialists, the prognosis of４２％ of the cerebral infarction patientswas related to the absence of stroke specialists, and to geographical disadvantages. In４８％ of thecerebral infarction patients in the areas without stroke specialists, the lapse time after the onset ofcerebral infarction exceeded３h at their initial examinations. However, this is considered likely tobe improved by the implementation of stroke awareness activities.DISCUSSION:Cerebral infarction, which is common in the elderly, is expected to increase in frequency andseverity in the future. Therefore, rigorous prevention, awareness activities to spread super-acutestroke treatment using t‐PA, and medical environmental improvement are necessary.

• 2012-04-25

著者

• 里見 淳一郎

  徳島大学 脳神経外科

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