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II保険医療圏と徳島大学脳卒中センターとの比較検討

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

四国医学雑誌 : http://www.tokushima-u.ac.jp/med/research/shikoku_acta_medica.html