杏林大学病院における大都市型stroke unitの新規開設における戦略 : tPA静注療法施行体制確立の観点から  [in Japanese] The Strategy for Establishment of the System of Intravenous t-PA Therapy in a New Urban-type Stroke Unit of Kyorin University Hospital  [in Japanese]

Kyorin University Hospital covers a medical zone near the center of Tokyo, with a population of about 920,000. The hospital established a new urban-type stroke unit for this medical zone in May 2006. Reviewing the problems facing the previous system of treatment of stroke, the hospital decided to establish a new stroke care team to take care of all treatments for stroke patients at the hospital and ensure that intravenous t-PA therapy can be performed 24 hours a day. Over a 1-year period before the stroke unit opened, a total of 662 stroke patients were treated at the hospital, but about 80 patients with transient ischemic attack (TIA) or mild cerebral infarction could not be hospitalized. The major problems facing the hospital were that comprehensive management was not provided uniformly to stroke patients and attention was not being paid to patients with TIA or mild stroke who are at risk of severe stroke and its recurrence and require intervention the most. The stroke unit opened with the following 4 strategies: 1) to accept patients with TIA or mild cerebral infarction non-selectively for short periods of time with close examination; 2) to apply an advanced hyperacute rehabilitation program to patients with moderate stroke for improved recovery of activities of daily living (ADL) and to achieve early intervention by social workers dedicated to the stroke unit to smooth the transition to rehabilitation hospitals; 3) to minimize medical complication in severe stroke patients by preventing aspiration pneumonia and decubitus by thorough body position management; and 4) to increase the awareness of a system for intravenous t-PA therapy among nearby hospitals and ambulance teams. Using these strategies and measures, a total of 872 patients were admitted (549 men, 323 women; mean age, 70.2 years) over an 18-month period since the stroke unit opened. All the patients with TIA and mild cerebral infarction were hospitalized and actively managed for examination and treatment. Intravenous t-PA therapy was considered in 160 patients and finally performed on 66 patients according to the strict indication of the therapy. Establishment of the intravenous t-PA therapy system has been very effective in improving overall management for stroke patients.