การพัฒนาเครือข่ายโรคหลอดเลือดสมองภาคอีสาน

Abstract

The prevalence rate of stroke is high at 1,880 patients per 1000,000 population in age group of 45-8- years. The standard tratment for acute ischemic stroke is recombinant tissue plasminogen activator (rt-PA) within 4.5 hours of stroke onset. In 2006, the first report of rt-PA treatment in Thailand has been published with successful outcomes in 34 patients. Later on, the rt-PA has been used more but only in university hospitals and large private hopitals; mostly in Bangkok. In 2008, the rate of the rt-PA treatment in THailand was quite low at 0.01%. The other 55 million people outside Bangkok, the majority of Thailand population have very low chance to receive rt-PA treatment due to limitation of CT machine and medical personals. In the northeasthern Thailand, there were 22 million people in 20 provinces. Only 22 neurologists practiced in 9 big provinces. To facilitate rt-PA use for acute stroke patients in Thailand, acute stroke care should be managed by the internists instead of neurologists. In addition, several factors may be associated with stroke outcomes such as patient recognition, stroke care team, or availability of CT machine. Stroke network therefore is established to improve acute stroke care The stroke network project is comprised of main server and client hospitals. The main server hospitals are teriary care hoapitals in each medical service area and be able to provide-rt-PA treatment for all client hoapitals in the service areas. Roles of the main server hospitals are 1) providing rt-PA treatment for acute ischemic stroke patients, 2) setting up comprehensive stroke unit, and 3) a clinical guideline for stroke fast track and acute ischemic stroke care for their service areas, 4) being consultant for their client hospitals regarding of acute stroke care, 5) monitoring the client hospitals and improving the client hospitals services, and 6) proving inter-hospital conferences regarding acute stroke care among main service hospitals and client hospitals yearly