Observation on early effects of systematic treatment model with subjects for ACVD
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《中华医药杂志》英文版
【Abstract】 Objective To study the effects of systematic treatment model with subjects for ACVD patients (STMSACVD). Methods 7202 patients in hospital were eligible for the criteria that the patients were admitted with ACVD in 7 days.Of all patients,4089 were allocated to treatment group (admitted from June 2000 to June 2005); 3113 were enrolled as control group (conventionally treated before June 2000). STMSACVD was used in the treatment group that includes the department of Neurology, Neurosurgery, Rehabilitation, and lnterventional Radialogy. It was used in the patients with TIAs, cerebral infarctioncl (CI), cerebral hemorrhage (CH) or subarachnoid hemorrhage (SAH) so as to provide those patients best services, monitoring, earlier rehabilitation and traditional medical interventional treatment. Parameters were observed at discharge with regard to curative rate, total effective rate, mortality,inhospital days, complications and ratio of treat-drug. All parameters were analyzed with SPSS softwere. Results Curative rate, total effective rate, mortality, average inhospital days, complicantions, and average ratio of treat-drug were significantly better in the treatment group than those in the control group (P<0.001). Conclusion STMSACVD may reduce the mortality of the patients with ACVD, improve obviously curative rate, decrease the disability, increase the ability returning society, but dont increase patients economic charge.
【Key Words】 ACVD; systematic treatment model with subjects; effects
INTRODOCTION
Cerebrovascular disease (CVD) is a major killer in the 21 century ering the health of human beings. The incidence, mortality and disability rate of CVD progresssing year after year[1].At present, cerebrovascular disease is the biggest health problem in China. Some new diagnostic methds and therapeutic technologies for ACVD were discoveried continuously[2].Assembling and analyzing the recent progressions in respects of treating CVD, we explored the systematic treatment model with subjects for ACVD (STMSACVD). Now, early effects with STMSACVD in the patients with ACVD are reported as follows.
MATERIAL AND METHODS
Criteria (1) Within 7 days after ictus of ACVD, including the patients with TIAs, exacerbating cerebral infarction, mediate or severe cerebral infarction, subarachnoid hemorrhage and mediate or mass hemorrhage (cerebellum≥7ml, supratentorial≥20ml);(2)The first time patients and recurrent patients who were surviving without any sequelas. (3)Age 20~75yrs and volunteers.(4)Eligible to the diagnostic criteria modified by “National Fourth cerebrovascular congress”, and document by cranial CT or MRI.
Subjects 7202 patients were eligible for criteria, 4089 of 7202 patients were divided into the treament group (STMSACVD) who were admitted from June,2000 to June,2005. Male 2453 cases. Female 1636 cases. Age 30~75 (62±13) yrs. The patients included 2860(69.94%) ischemic cases and 1229(30.06%) hemorrhage cases. Of 4089 cases, 429 cases was TIAs. 974 were exacerbating CI, 1460 were mediate or severe cerebral infarction,150 were SAH. 1076 were mediate or mass CH. 3113 patients were divided into the control group(conventional therapy before June,2000)who were admitted form May, 1995 to May, 2000.Male 1867 cases, and Femal 1246. Age 28~75(59±15) yrs. Ischemic patients were 1180 cases (>70.61%), and hemorrhage ones were 915 (29.39%). Of 3113 cases, 327 were TIAs, 741 exacerbating CI;1112 mediate or severe CI, 102 SAH, 813 mediate or mass CH. It was not significant comparing the general materials of both groups (p>0.05). According to the score of clinical neurological function deficit in the patients with ACVD (CSS)[3], the average score of all patients in the treatment group was 26.00±9.82, the one in the control group was 24.50±9.52. It was not significant between the treatment group and control group.
METHODS
Model Managing uniformly under the centre of treating CVD,the departments of neurology, Neurosurgery, Rehabilitation and interventional neuroradialogy were integrated as a team to complete those tasks. Moreover, it was built that the patients were managed rapid by emergence medical works(called asgreen channel which included First aid, emergence room,every subject and system of special clinic et).
Process administered In the treatment group, as a team, we underlined the principles that every duty was accomplished through out, the patients were admitted to the assigned ward according to the rules,these patients might move to the best suitable ward during in hospital days and must be treated according to the standard medical plans. ① The department of neurology was responsive for the pharmacological (intravenous or intraarterial) thrombolysis before the early stage after the ictus of CI inventional neuroradialogy (DSA, stenting), intensive care unit(ICU), prophylaxis and treatment of the complications nursing, monitoring blood pressure, regulating blood glucose, traditional herbs and antiplatelet aggregating agents, anticoagulants, and fibroprotein-lowering drugs and so on. ② The department of neurosurgery was responsive for hematomatomy with microscopic neurosurgery in the patients with mediate or severe CH, hematoma-sucking early for CH with stereoscopic direction technology, DSA in SAH, interventional radialogy or microscopic neurosurgery for cerebral aneurysm, subtemporal DEC ompression with cranial bone-section, recanalization between cranial inter-and extra-vasculars, ICU and so on. ③ The department of rehabilitation was responsive for all of patients with ACVD anywhere and rehabilitating according to the standard, building rehabilitating net, and when necessary the patients were transported to the rehabilitation ward. In a word, all medical works must carry strictly out the clinical working programs, use the remedial service system standard in time, and make every patient got the best treatment[4].The control group : on the basis of convention remedial ways, the patients with variable types of ACVD were treated in the place of neurology, neurosurgery or rehabilitation. The remedial measures were not uniform or standard, no ICU, no special nursing, no rehabilitating plan.
Effect evaluation According CSS, the patients were evaluated at discharge. Cure: the score of neurologic function deficit was reduced about 91~100%, degree of disability was 0 grade; Clear effect: the score of neurologic function deficit was reduced about 46~90%, degree of disability was 1~3 grade. Improvement : the score of neurologic function deficit was reduced about 18~45%. Nullness or exacerbation: the score of neurologic function deficit was reduced less than 17% or death.
Statistical analysis SPSS software was adopted. The test was used for comparing two samples average. The χ2 test was used for comparing the other variables. There was a significant difference statistically if P was bess than 0.05, and very significant difference if P was less than 0.01.
RESULTS
Evaluating the clinical effects at discharge, there was a significant difference comparing the curative rate, total effective rate, mortality in the treatment group with the control group(see table 1).
Evaluating the subordinate indexes at discharge, there was a significant difference comparing the complications, average inhospital days and the cost of drugs between treatment group and control group (see table 2).
DISCUSSION
At present, treating CVD in major domestical hospital is still the remedial model primarily using pharmacotherapy, which has very affected remedial effect, and made the medical sources waste, got the patients not to gain the best medical service. Domestical or international documents showed that Stroke Unit was the most effective way treating CVD, and make the clinical practice of CVD look brand-New[5-7].
STMSACVD” is a new systematic project for treating ACVD(medical management model), in accord with modern-day Stroke Unit in terms of its essential content [2,8,9].“STMSACVD”has expanded the medical field treating various types of ACVD, and got the patients acquiring better profits.
At the moment, the study on stroke unit demostically or internationally has focused greatly to CI. But, our STMSACVD includes TIAs, exacerbating CI,mediate or severe CI, mediate or mass CH and SAH, that is to say, integating cerebrovascular medcine, surgery, rehabilitotion, interventional radialogy and other departments as a team treats the patients under the uniform leader, STMSACVD emphases the cooperation among subjects, strictly administering the clinical standard remedial plans, quickly admiting the patients to the adaptive ward (or ICU), opening “green channel”, rationally moving the patients among subjects, early rehabilitating, making every patient gained the test effective medical treatment.
Our study show that STMSACVD is very beneficial for the patient with ACVD; under the prereguisite of limiting strictly for admitting patients to every sutject, acute ischemic or hemorrhage CVD patients are treated with the best medical or omnibearing service. 7202 patients were studied, eligible for the mediate or severe criteria of ACVD. This study is very valuable. And its reliability is very high. The results show that in hospital days, cure, total effect and mortality is better in the trentment group than control group, a significant difference (P<0.001) between two groups. This is because that all of inhospital ACVD patients in the treatment group were treated by STMSACVD, adopting the standard diagnostic criteria, indiual remedial plans, ICU and early rehablitation.Moreover, 1~3 weeks after ACVD is a time that variable complicants occur easiliest[5,9]. Subjects administed relative standard medical rules to abserve and treat the patients. Every plan was carried out seriously. It is special attention that rehabilitation is done as early as possible, expertise nursing is implemented, and the complications are prevented effectually. There is a significant difference in the complications comparing the treatment group with control group (P<0.001). For this reasons,the mortality in the treatment group is lowered greatlier. Furthermore, Curative rate and total effect are rised greatlier, and the patients prognosis is improved obuviosly.
Other results analysis: In terms of average inhospital days, it is shorter in the treatment group than control group, and there is a very significant (P<0.001), because that the STMSACVD can transfer various active factors of subjects to treat rationally the patients, spur the patients neurologic dysfunction recovered as soon as possible. With regard to the average cost of drugs during the hospital days, it is less in the treatment group than control group, and there is a very significant difference (p﹤0.001). The study proves that the clinical implementation of STMSACVD changes the remedial model using primarily pharmacothraphy, which is adopt in the major domestical hospitals at present. Shortening the average hospital days and lessening the cost of drugs, then, must reduce obvionsly the cost of patients.
In a word, the study announces that the STMSACVD is a brand new remedial system. After practising clinically it can raise curative rate, reduce mortality, improve the every day lifes ability in the survivors, lower the neurological dysfunction, recover evidently the social contacts. And the same time lighten the social or familys economic load for the patients.
REFERENCES
1 Gubitz G, Sander cock P. Acute ischae mic stroke BMJ,2000,320:692-696.
2 Wang Yongjun. Organized remedial system for stroke. Chinese medical information Guide,2002,18:20-21.
3 The fourth national cerebrovascular disease congress. The score at Clinical neurologic fanction deficit for the patients with CVD (1995). Chinese Journal of Neurology,1996,29(6):38-383.
4 Adams HP, Adams RJ, Brott TB, et al. Guideline fer early manage ment of patients with ische mic stroke: a sciertific state ment from the stroke council of the American Stroke Association.Stroke,2003,34:1055-1083.
5 Wang Yongjun. Stroke unit.Modern Rehabilitation,2001,5(2):16-17.
6 Hong Zheng. Organized stroke unit system. Chinese Prescription Drugs,2003,11:28-30.
7 Sinha S, Warburton EA.The evolution of stroke unit-towards a more intensive appoach.QJM,2000,93:633-638.
8 Wang Yongjun. Model and building on stroke unit. Chinese medical Journal,2004,39(1):12-13.
9 Philps SJ, Eskes G, Gubitz GJ, at al. Description and evaluation of an acute stroke unit. CMAJ,2002,167:655-660.
*This project is supported by Hebei province science fund (00276154 D)
Treatment Centre of Cerebrovascular Disease,3rd Hospital of Xingtai,Xingtai, Hebei Province 054000,China
(Editor Ding Hai-yan)(WANG Lian-qin，NING Hai-ch)
【Key Words】 ACVD; systematic treatment model with subjects; effects
INTRODOCTION
Cerebrovascular disease (CVD) is a major killer in the 21 century ering the health of human beings. The incidence, mortality and disability rate of CVD progresssing year after year[1].At present, cerebrovascular disease is the biggest health problem in China. Some new diagnostic methds and therapeutic technologies for ACVD were discoveried continuously[2].Assembling and analyzing the recent progressions in respects of treating CVD, we explored the systematic treatment model with subjects for ACVD (STMSACVD). Now, early effects with STMSACVD in the patients with ACVD are reported as follows.
MATERIAL AND METHODS
Criteria (1) Within 7 days after ictus of ACVD, including the patients with TIAs, exacerbating cerebral infarction, mediate or severe cerebral infarction, subarachnoid hemorrhage and mediate or mass hemorrhage (cerebellum≥7ml, supratentorial≥20ml);(2)The first time patients and recurrent patients who were surviving without any sequelas. (3)Age 20~75yrs and volunteers.(4)Eligible to the diagnostic criteria modified by “National Fourth cerebrovascular congress”, and document by cranial CT or MRI.
Subjects 7202 patients were eligible for criteria, 4089 of 7202 patients were divided into the treament group (STMSACVD) who were admitted from June,2000 to June,2005. Male 2453 cases. Female 1636 cases. Age 30~75 (62±13) yrs. The patients included 2860(69.94%) ischemic cases and 1229(30.06%) hemorrhage cases. Of 4089 cases, 429 cases was TIAs. 974 were exacerbating CI, 1460 were mediate or severe cerebral infarction,150 were SAH. 1076 were mediate or mass CH. 3113 patients were divided into the control group(conventional therapy before June,2000)who were admitted form May, 1995 to May, 2000.Male 1867 cases, and Femal 1246. Age 28~75(59±15) yrs. Ischemic patients were 1180 cases (>70.61%), and hemorrhage ones were 915 (29.39%). Of 3113 cases, 327 were TIAs, 741 exacerbating CI;1112 mediate or severe CI, 102 SAH, 813 mediate or mass CH. It was not significant comparing the general materials of both groups (p>0.05). According to the score of clinical neurological function deficit in the patients with ACVD (CSS)[3], the average score of all patients in the treatment group was 26.00±9.82, the one in the control group was 24.50±9.52. It was not significant between the treatment group and control group.
METHODS
Model Managing uniformly under the centre of treating CVD,the departments of neurology, Neurosurgery, Rehabilitation and interventional neuroradialogy were integrated as a team to complete those tasks. Moreover, it was built that the patients were managed rapid by emergence medical works(called asgreen channel which included First aid, emergence room,every subject and system of special clinic et).
Process administered In the treatment group, as a team, we underlined the principles that every duty was accomplished through out, the patients were admitted to the assigned ward according to the rules,these patients might move to the best suitable ward during in hospital days and must be treated according to the standard medical plans. ① The department of neurology was responsive for the pharmacological (intravenous or intraarterial) thrombolysis before the early stage after the ictus of CI inventional neuroradialogy (DSA, stenting), intensive care unit(ICU), prophylaxis and treatment of the complications nursing, monitoring blood pressure, regulating blood glucose, traditional herbs and antiplatelet aggregating agents, anticoagulants, and fibroprotein-lowering drugs and so on. ② The department of neurosurgery was responsive for hematomatomy with microscopic neurosurgery in the patients with mediate or severe CH, hematoma-sucking early for CH with stereoscopic direction technology, DSA in SAH, interventional radialogy or microscopic neurosurgery for cerebral aneurysm, subtemporal DEC ompression with cranial bone-section, recanalization between cranial inter-and extra-vasculars, ICU and so on. ③ The department of rehabilitation was responsive for all of patients with ACVD anywhere and rehabilitating according to the standard, building rehabilitating net, and when necessary the patients were transported to the rehabilitation ward. In a word, all medical works must carry strictly out the clinical working programs, use the remedial service system standard in time, and make every patient got the best treatment[4].The control group : on the basis of convention remedial ways, the patients with variable types of ACVD were treated in the place of neurology, neurosurgery or rehabilitation. The remedial measures were not uniform or standard, no ICU, no special nursing, no rehabilitating plan.
Effect evaluation According CSS, the patients were evaluated at discharge. Cure: the score of neurologic function deficit was reduced about 91~100%, degree of disability was 0 grade; Clear effect: the score of neurologic function deficit was reduced about 46~90%, degree of disability was 1~3 grade. Improvement : the score of neurologic function deficit was reduced about 18~45%. Nullness or exacerbation: the score of neurologic function deficit was reduced less than 17% or death.
Statistical analysis SPSS software was adopted. The test was used for comparing two samples average. The χ2 test was used for comparing the other variables. There was a significant difference statistically if P was bess than 0.05, and very significant difference if P was less than 0.01.
RESULTS
Evaluating the clinical effects at discharge, there was a significant difference comparing the curative rate, total effective rate, mortality in the treatment group with the control group(see table 1).
Evaluating the subordinate indexes at discharge, there was a significant difference comparing the complications, average inhospital days and the cost of drugs between treatment group and control group (see table 2).
DISCUSSION
At present, treating CVD in major domestical hospital is still the remedial model primarily using pharmacotherapy, which has very affected remedial effect, and made the medical sources waste, got the patients not to gain the best medical service. Domestical or international documents showed that Stroke Unit was the most effective way treating CVD, and make the clinical practice of CVD look brand-New[5-7].
STMSACVD” is a new systematic project for treating ACVD(medical management model), in accord with modern-day Stroke Unit in terms of its essential content [2,8,9].“STMSACVD”has expanded the medical field treating various types of ACVD, and got the patients acquiring better profits.
At the moment, the study on stroke unit demostically or internationally has focused greatly to CI. But, our STMSACVD includes TIAs, exacerbating CI,mediate or severe CI, mediate or mass CH and SAH, that is to say, integating cerebrovascular medcine, surgery, rehabilitotion, interventional radialogy and other departments as a team treats the patients under the uniform leader, STMSACVD emphases the cooperation among subjects, strictly administering the clinical standard remedial plans, quickly admiting the patients to the adaptive ward (or ICU), opening “green channel”, rationally moving the patients among subjects, early rehabilitating, making every patient gained the test effective medical treatment.
Our study show that STMSACVD is very beneficial for the patient with ACVD; under the prereguisite of limiting strictly for admitting patients to every sutject, acute ischemic or hemorrhage CVD patients are treated with the best medical or omnibearing service. 7202 patients were studied, eligible for the mediate or severe criteria of ACVD. This study is very valuable. And its reliability is very high. The results show that in hospital days, cure, total effect and mortality is better in the trentment group than control group, a significant difference (P<0.001) between two groups. This is because that all of inhospital ACVD patients in the treatment group were treated by STMSACVD, adopting the standard diagnostic criteria, indiual remedial plans, ICU and early rehablitation.Moreover, 1~3 weeks after ACVD is a time that variable complicants occur easiliest[5,9]. Subjects administed relative standard medical rules to abserve and treat the patients. Every plan was carried out seriously. It is special attention that rehabilitation is done as early as possible, expertise nursing is implemented, and the complications are prevented effectually. There is a significant difference in the complications comparing the treatment group with control group (P<0.001). For this reasons,the mortality in the treatment group is lowered greatlier. Furthermore, Curative rate and total effect are rised greatlier, and the patients prognosis is improved obuviosly.
Other results analysis: In terms of average inhospital days, it is shorter in the treatment group than control group, and there is a very significant (P<0.001), because that the STMSACVD can transfer various active factors of subjects to treat rationally the patients, spur the patients neurologic dysfunction recovered as soon as possible. With regard to the average cost of drugs during the hospital days, it is less in the treatment group than control group, and there is a very significant difference (p﹤0.001). The study proves that the clinical implementation of STMSACVD changes the remedial model using primarily pharmacothraphy, which is adopt in the major domestical hospitals at present. Shortening the average hospital days and lessening the cost of drugs, then, must reduce obvionsly the cost of patients.
In a word, the study announces that the STMSACVD is a brand new remedial system. After practising clinically it can raise curative rate, reduce mortality, improve the every day lifes ability in the survivors, lower the neurological dysfunction, recover evidently the social contacts. And the same time lighten the social or familys economic load for the patients.
REFERENCES
1 Gubitz G, Sander cock P. Acute ischae mic stroke BMJ,2000,320:692-696.
2 Wang Yongjun. Organized remedial system for stroke. Chinese medical information Guide,2002,18:20-21.
3 The fourth national cerebrovascular disease congress. The score at Clinical neurologic fanction deficit for the patients with CVD (1995). Chinese Journal of Neurology,1996,29(6):38-383.
4 Adams HP, Adams RJ, Brott TB, et al. Guideline fer early manage ment of patients with ische mic stroke: a sciertific state ment from the stroke council of the American Stroke Association.Stroke,2003,34:1055-1083.
5 Wang Yongjun. Stroke unit.Modern Rehabilitation,2001,5(2):16-17.
6 Hong Zheng. Organized stroke unit system. Chinese Prescription Drugs,2003,11:28-30.
7 Sinha S, Warburton EA.The evolution of stroke unit-towards a more intensive appoach.QJM,2000,93:633-638.
8 Wang Yongjun. Model and building on stroke unit. Chinese medical Journal,2004,39(1):12-13.
9 Philps SJ, Eskes G, Gubitz GJ, at al. Description and evaluation of an acute stroke unit. CMAJ,2002,167:655-660.
*This project is supported by Hebei province science fund (00276154 D)
Treatment Centre of Cerebrovascular Disease,3rd Hospital of Xingtai,Xingtai, Hebei Province 054000,China
(Editor Ding Hai-yan)(WANG Lian-qin，NING Hai-ch)