선진국의 뇌졸중집중치료서비스 모형과 실제

이원영,배희준 대한신경과학회 2009 대한신경과학회지 Vol.27 No.3

Background: It has been reported that organized inpatient (stroke unit) care reduces the mortality rate, and the need for institutional care or dependent living after stroke. Based on this evidence, stroke units have becomes popular among large-scale hospitals in developed countries. The aim of this study was to provide perspective regarding the efficacy of stroke units and their current status in developed countries. Methods and Results: An electronic search was conducted using the Cochrane Database, PubMed, and other online databases, in addition to a manual search. The efficacy of stroke-unit care compared to general-ward care was summarized and is presented with respect to death, death or institutional care, and death or dependency by the end of the scheduled follow-up. Current concepts and the status of stroke-unit services among developed countries were reviewed and compared with each other. The desirable models of stroke-unit services are discussed in terms of the stroke center. Conclusions: Stroke is the second leading cause of death in Korea and there that stroke-unit care is effective at improving the outcome of stroke patients. The expeditious development and realization of organized inpatient care for stroke victims should be a Government priority. Background: It has been reported that organized inpatient (stroke unit) care reduces the mortality rate, and the need for institutional care or dependent living after stroke. Based on this evidence, stroke units have becomes popular among large-scale hospitals in developed countries. The aim of this study was to provide perspective regarding the efficacy of stroke units and their current status in developed countries. Methods and Results: An electronic search was conducted using the Cochrane Database, PubMed, and other online databases, in addition to a manual search. The efficacy of stroke-unit care compared to general-ward care was summarized and is presented with respect to death, death or institutional care, and death or dependency by the end of the scheduled follow-up. Current concepts and the status of stroke-unit services among developed countries were reviewed and compared with each other. The desirable models of stroke-unit services are discussed in terms of the stroke center. Conclusions: Stroke is the second leading cause of death in Korea and there that stroke-unit care is effective at improving the outcome of stroke patients. The expeditious development and realization of organized inpatient care for stroke victims should be a Government priority.

Projected Numbers of Ischemic Strokes Recorded in the Austrian Stroke-Unit Registry from 2012 to 2075

Wolfgang Hitzl,Eugen Trinka,Leonard Seyfang,Sebastian Mutzenbach,Katharina Stadler,Slaven Pikija,Monika Killer,Erasmia Broussalis 대한신경과학회 2016 Journal of Clinical Neurology Vol.12 No.4

Background and Purpose This study analyzed the number of patients with ischemic strokes recorded in the Austrian Stroke-Unit Registry with the aim of projecting this number from 2012 to 2075 and to highlight that the Austrian health system will face a dramatic in¬crease in older patients within the next few decades. Methods Current demographic information was obtained from EUROSTAT, and informa¬tion on age- and sex-stratified 1-year incidence rates of ischemic stroke were obtained from the Austrian Stroke-Unit Registry. Sensitivity analysis was performed by analyzing the pro¬jections based on predicted ageing, main, and growth population scenarios, and with stratifi¬cation by age and gender. Results The total number of ischemic strokes recorded in the Austrian Stroke-Unit Regis¬try was 8,690 in 2012 and is expected to increase to 15,826, 15,626, or 18,134 in 2075 accord¬ing to the ageing, main, and growth scenarios, respectively. The corresponding numbers of patients are projected to increase or decrease within different age strata as follows (100%=num¬ber of registered ischemic strokes in 2012): 0–40 years, 100%/99% (males/females); 40–50 years, 83%/83%; 50–60 years, 98%/97%; 60–70 years, 126%/119%; 70–80 years, 159%/139%; 80–90 years, 307%/199%; and 90+ years, 894%/413%. Conclusions The ageing population in Austria will result in the number of patients increasing considerably from 2012 to 2075, to 182%, 180%, or 208% (relative to 100% in 2012) according to the ageing, main, and growth scenarios, respectively; the corresponding value among those aged 80+ years is 315%, 290%, or 347%. These figures demonstrated the importance of improving pri¬mary preventive measures. The results of this study should provide a basis for discussions among health-care professionals and economists to face the future large financial burden of ischemic stroke on the Austrian health system.

Stroke Epidemiology and Stroke Care Services in India

Jeyaraj Durai Pandian,Paulin Sudhan 대한뇌졸중학회 2013 Journal of stroke Vol.15 No.3

Developing countries like India are facing a double burden of communicable and non-communicable diseases. Stroke is one of the leading causes of death and disability in India. The estimated adjusted prevalence rate of stroke range, 84-262/100,000 in rural and 334-424/ 100,000 in urban areas. The incidence rate is 119-145/100,000 based on the recent population based studies. There is also a wide variation in case fatality rates with the highest being 42% in Kolkata. Stroke units are predominantly available in urban areas that too in private hospitals. Intravenous (IV) and intra-arterial thrombolysis (IA) are commonly used in India. In the on-going Indo USA National stroke registry the rate of IV thrombolysis is 11%. Stroke rehabilitation is not well developed in India due to lack of personnel. Organised rehabilitation services are available in the country but they are mainly in private hospitals of the cities. Even though India is a leading generic drugs producer still many people can’t afford the commonly used secondary prevention drugs. As a first step the Government of India has started the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS). The government is focusing on early diagnosis, management, infrastructure, public awareness and capacity building at different levels of health care for all the non-communicable diseases including stroke. An organised effort from both the government and the private sector is needed to tackle the stroke epidemic in India.

뇌졸중 환자의 재활치료에 있어서 타과 의뢰 기반 치료와 입원치료의 비교

김유수 대한뇌졸중학회 2005 Journal of stroke Vol.7 No.1

Department of Rehabilitation medicine, Seoul National University College of medicine,Seoul National University Boramae Hospital*Background: The purpose of this study was to investigate factors related to the functional outcome of stroke patients at discharge. Methods: Retrospective analysis of existing medical records of 202 stroke patients was performed. Checked variables were: 1) whether the patient was transferred to the rehabilitation unit or not, 2) functional outcome at discharge, 3) the length of hospital stay and rehabilitation course, 4) risk factors such as hypertension, heart disease, diabetes mellitus, and hypercholesterolemia, 5) department of admission, 6) dischar g e course. The factors associated with functional outcome at discharge were analyzed using multiple logistic regression analysis. Results: A multivariate analysis revealed that the following factors were found to be associated with good functional outcome at discharge: 1) ischemic stroke (OR=5.733, p=0.003), 2) transfer to the rehabilitation unit (OR=7.004, p=0.001 ). Factors such as risk factors, department of admission, discharge course, length of hospital stay and rehabilitation course showed no significant association with good functional outcome at discharge. Conclusions: Although there may be selection bias, whether the patient was transferred to the rehabilitation unit or not is the strongest prognostic factor for the functional outcome at discharge. Therefore, it seems important for the stroke patients be treated at the rehabilitation unit.

심방세동 발견에 있어 뇌졸중 치료실의 유용성

서주연 대한뇌졸중학회 2007 Journal of stroke Vol.9 No.1

Background: Detection of atrial fibrillation (AF), either permanent or paroxysmal, is important in stroke patients because itspresence requires life-long anticoagulation for prevention of recurrent stroke. The aim of this study was to investigate the effectof continuous electrocardiography (ECG) monitoring in the stroke unit (SU) for the detection of AF. Methods: Subjects enrolledfor this study were the patients who had admitted due to acute ischemic stroke before and after operation of the SU. All patientswere monitored by continuous ECG during their stay in the SU. The frequency of AF, which were documented at admission anddetected during their hospitalization, was compared in them. Results: Total 937 patients had admitted to the general ward(GW) before the SU opened and 1605 patients to the GW or SU after the SU opened. Among patients admitted after the SU opened,1074 patients (66.9%) were stayed in the SU during their hospitalization (mean 4.4 days). AF was found in 144 patients (15.4%)among those admitted before the SU opened and in 281 (17.5%) among those admitted after the SU. The frequency of AF documentedat admission was not different between the groups (14.4% in the before SU, 15.1% in the after SU, 〈0.05). Thefrequency of newly detected AF (3.8%) among patients who admitted to the SU was significantly higher than those admitted tothe GW before (1.1%) or after the SU opened (0.6%)(P〈0.001). Conclusion: The detection rate of AF in acute ischemic strokepatients has been increased significantly by continuous ECG monitoring in the SU. (Korean Journal of Stroke 2007;9:37-41)

Loss of Integrity: Impairment of the Blood-brain Barrier in Heavy Metal-associated Ischemic Stroke

Jeong-Hyeon Kim,Hyeong-Min Byun,Eui-Cheol Chung,Han-Young Chung,Ok-Nam Bae 한국독성학회 2013 Toxicological Research Vol.29 No.3

Although stroke is one of the leading causes of death and disability worldwide, preventive or therapeutic options are still limited. Therefore, a better understanding of the pathophysiological characteristics of this life-threatening disease is urgently needed. The incidence and prevalence of ischemic stroke are increased by exposure to certain types of xenobiotics, including heavy metals, suggesting the possible toxicological contribution of these compounds to the onset or aggravation of stroke. Among the potential targets, we have focused on alterations to cerebral endothelial cells (CECs), which play important roles in maintaining the functional integrity of brain tissue.

경희의료원 제3 중환자실(동서협진중환자실)에 입원한 89명의 중증 급성기 뇌경색 환자에 대한 임상적 고찰

허홍,소형진,임주혁,조인영,이혜영,민경윤,류재환,이범준,Heo, Hong,So, Hyung-Jin,Im, Ju-Hyuk,Cho, In-Young,Lee, Hae-Yong,Min, Kyoung-Yoon,Ryu, Jae-Hwan,Lee, Beom-Jun 대한한방내과학회 2007 大韓韓方內科學會誌 Vol.28 No.4

Objects : To gain better insights of East-west integrated treatment of ischemic stroke. We analyzed 89 patients with severe acute ischemic stroke who were admitted to the East-west integrated intensive care unit. Methods : Subjects enrollment was from the East-west integrated intensive care unit of Kyung Hee Medical Center from March 2006 to February 2007. Patients were admitted within 14 days after the onset of ischemic stroke. We assessed the subjects' general characteristics, risk factors, admitting routes and periods, diagnostic imaging, process of western treatment and Korean traditional treatment, complication and consequence. Results : The proportion of males was 50.6%, of females 49.4%, average age was male 66.0$\pm$10.3 and female 71.1$\pm$10.5. Average length of hospital stays was 19.5 days. Monthly admissions were highest in November and December. The admission route was through emergency room (61.8%) or ward (34.8%). Mean Glasgow coma scale score was 10.0$\pm$2.5, average time from symptom of onset to hospital admission was 2.3$\pm$2.2 days. Dominant ischemic vascular territory was middle cerebral artery (66.3%). Initial western treatment was argatroban (22.5%), urokinase (28.1%), and heparinization (38.2%). Distribution of Sasang constitution of So-yang to Tae-eum to So-eum was equal to 5.4 to 2.9 to 1.5. Major complications were observed in 40 (42.7%) patients. In hospital mortality was 12.4% (11 deaths), all of them caused by aggravation of neurological deficit and only 3 of them with major complications. There appears to be a significant positive relationship between length of hospital stay and occurrence of complications (P<0.05). After discharge from the ICU, 64 (71.9%) patients were improved, 11 (12.4%) patients had expired, and 14 (15.8%) patients were transferred. Conclusions : From this study, we suggest that patients with severe acute ischemic stroke should be treated with East-west integrated therapy for more favorable consequences and decreased mortality.

Beneficial Effects of Stroke-Unit Care in Stroke Patients with Atrial Fibrillation

최혜윤,서주현,양재훈,김영대,정요한,조한진,허지회,남효석,최혜연 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.2

Purpose: Continuous cardiac monitoring in a stroke unit (SU) may improve detection of atrial fibrillation (AF), and SU care may improve the rate of anticoagulation by better adherence to a standardized treatment protocol in patients with AF. We investigated the effects of the SU on the detection of AF and the rate of warfarin therapy in patients with AF. Materials and Methods: Acute stroke patients who had been admitted before or after the opening of the SU were included in our study. SU patients were monitored continuously with electrocardiography. Rates of AF and warfarin therapy were compared between patients admitted to the SU (SU group) and those admitted to the general ward (GW) prior to the opening of the SU (GW group). Results: Total 951 patients had been admitted to the GW prior to the opening of the SU (from January 2000 to November 2002), and 2349 patients to the SU (from January 2003 to December 2008). AF was found in 149 patients (15.7%) in the GW group and in 487 (20.7%) in the SU group. Most of AF detected during admission was paroxysmal AF (84.8%). The frequency of newly detected AF was higher in the SU group than the GW group (2.5% vs. 0.7%, p=0.001). The rate of anticoagulation consideration was also higher in the SU group. Conclusion: SU care improved the detection of AF and the rate of anticoagulation consideration in acute stroke patients. Our findings support the benefits of continuous cardiac monitoring in the SU for stroke patients.

압력 바이오피드백 제공에 따른 고유수용성신경근촉진법 하지패턴 적용이 뇌졸중 환자의 근력과 보행능력에 미치는 영향

박진,송명수,Park, Jin,Song, Myung-Soo 대한고유수용성신경근촉진법학회 2020 PNF and Movement Vol.18 No.1

Purpose: The purpose of this study was to compare the strength and walking ability of chronic stroke patients following either proprioceptive neuromuscular facilitation (PNF) pattern training with pressure biofeedback units (feedback group) or PNF pattern training without pressure biofeedback units (control group). Methods: Eighteen participants with chronic stroke were recruited from a rehabilitation hospital. They were divided into two groups: a feedback group (n = 8) and a control group (n = 10). They all received 30 minutes of neurodevelopmental therapy and PNF training for 15 minutes five times a week for three weeks. Muscle strength and spatiotemporal gait parameters were measured. Muscle strength was measured by hand-held dynamometer; gait parameters were measured by the Biodex Gait trainer treadmill system. Results: After the training periods, the feedback group showed a significant improvement in hip abductor muscle strength, hip extensor muscle strength, step length of the unaffected limb, and step time of the affected limb (p<0.05). Conclusion: The results of this study showed that proprioceptive neuromuscular facilitation pattern training with pressure biofeedback units was more effective in improving hip muscle strength and walking ability than the proprioceptive neuromuscular facilitation pattern training without pressure biofeedback units. Therefore, to strengthen hip muscles and improve the walking ability of stroke patients, using pressure biofeedback units to improve trunk stability should be considered.

중환자실 간호사 배치수준과 허혈성 및 출혈성 뇌졸중 환자 사망의 관계

김주은(Kim, Ju-Eun),배성희(Bae, Sung-Heui) 한국간호행정학회 2021 간호행정학회지 Vol.27 No.5

Purpose: This study examined the association between nurse staffing and in-hospital 30-day mortality among stroke patients considering the stroke type in the intensive care units in Korea using the Health Insurance Review and Assessment Service-National Inpatient Sample 2018 (HIRA-NIS 2018). Methods: The data included a total of 2,876 stroke patients admitted to intensive care units across 72 general hospitals and 39 tertiary hospitals between January and November 2018. Nurse staffing levels were measured using the nurse staffing grades of adult intensive care units in the 2nd quarter of 2018. The relationship between nurse staffing levels and mortality were analyzed using multi-level logistic regression analysis after controlling for patient and hospital characteristics. Results: In patients with ischemic stroke, the risk of death was lower in nurse staffing Grade 5 to 6 compared to Grade 1 (Odds ratio [OR] 0.43, 95% Confidence interval [CI] 0.24~0.75). In hemorrhagic stroke patients, the risk of death tended to be higher in nurse staffing grade 5 to 6 compared to Grade 1 (OR 2.11, 95% CI 1.00~4.45), which was marginally significant (p=.050). Conclusion: Health policies for adequate nurse staffing in intensive care units should be implemented to enhance the quality of care and lead to better outcomes in patients with stroke.