October 29 this year is the 17th “World Stroke Day”. Today, setting up stroke centers, opening green channels, and conducting multidisciplinary diagnosis and treatment have become the “standard” for many medical institutions.
As the Shanghai Stroke Clinical Treatment Center, the Shanghai Key Clinical Specialty and the National Comprehensive Stroke Center, the Neurology Department of Shanghai Tenth People’s Hospital, under the leadership of Director Liu Xueyuan, has created a distinctive “Ten Hospital Model” for stroke. Continuously upgrade and improve in practice.
Only 30 minutes from admission to medication
The international standard time interval between entering the hospital and using thrombolytic drugs is 60 minutes, while it is 30 minutes in Shanghai Tenth Hospital. How is this done? Mr. Li, who has just been successfully treated, has a right to speak.
The 75-year-old Mr. Li suffered a stroke while walking alone. Confused and weak, he was sent to the Tenth Hospital by 120 ambulance. Through his mobile phone, the medical staff contacted his family at the first time.
Treatment had begun at the same time the family arrived at the hospital. A series of routine procedures such as queuing, registration, payment, and waiting for inspection were all omitted. The medical staff completed the CT and blood tests for Mr. Li in just 10 minutes, and was diagnosed with cerebral infarction.
Time is brain cells. The doctor obtained the informed consent of the family members on the treatment plan through telephone communication, and started the thrombolytic therapy for the first time. After the family members come to the hospital, they will pay the fee. Thanks to the fast and effective “green channel”, the old man recovered well and was discharged from the hospital without any sequelae such as language and limb dysfunction.
Mr. Li’s “lucky” is not an exception. According to Director Liu Xueyuan, the stroke center of the ten hospitals has completed an average of more than 400 cases of thrombolytic therapy and more than 200 cases of arterial thrombectomy each year, ranking among the top in the city.
Internal, external, medical, nursing and technical integration to find the culprit
The danger of a stroke is not only that it is “sick like a mountain” and prone to sequelae, but also that it often occurs multiple times, making it hard to prevent. Zhou Xiaoyu, deputy director of the Department of Neurology, emphasized that the construction of the stroke treatment system should not only be satisfied with thrombolysis and thrombectomy, but also to eliminate the soil in which the disease breeds, help patients find the deep-seated reasons behind the occurrence of stroke, and carry out scientific, standardized and effective measures for the “culprit”. Medical intervention to reduce recurrence is the proper meaning in the construction of the stroke treatment system. The Shanghai Tenth Hospital Stroke Center has established a multidisciplinary team integrating internal, external, medical, technical and nursing care, and operates efficiently at all times.
Zhang, a college student in his early 20s, suffered from numbness in his right limb after carrying heavy objects. After visiting the Tenth Hospital, he found out that it was a cerebral infarction! He and his relatives and friends were greatly surprised to suffer from “senile disease” at such a young age.
For this case, the medical staff were not satisfied with only completing the thrombolytic treatment, but initiated a multidisciplinary collaboration mechanism, which included neurology, neurosurgery, emergency department, radiology, nursing department, cardiology, thoracic surgery and other disciplines and The medical staff of the department consulted and successfully identified the “real culprit” behind the cerebral infarction – patent foramen ovale. This is a congenital heart disease in which the foramen ovale is not fully closed due to the dysplasia of the atrial septum, causing the blood to flow turbulently and create tiny blood clots, leading to stroke. In the end, Xiao Zhang was transferred to the Cardiothoracic Surgery Department for minimally invasive surgery, which successfully blocked the foramen ovale and prevented the recurrence of cerebral infarction.
Compared with Xiao Zhang’s special situation, the patients encountered by the multidisciplinary team of the Stroke Center of the Tenth Hospital often have metabolic problems such as hypertension, hyperlipidemia, diabetes, and heart diseases such as atrial fibrillation. If blood pressure, blood lipids, and blood sugar cannot be effectively controlled , If the arrhythmia is not relieved, the soil where the cerebral infarction occurs will always exist.
Ultra-early rehabilitation intervention within 24 hours of onset
With the improvement of the speed of treatment, more and more stroke patients can avoid life-threatening, but sequelae are still a serious problem. Therefore, it is another important link in the stroke treatment system to do everything possible to reduce or even avoid complications while thrombectomy and thrombectomy are saving patients’ lives.
Muscle loss, limb dysfunction, speech impairment, etc. are common sequelae of stroke. Both theoretical research and clinical practice have confirmed that the earlier rehabilitation treatment is started, the better the recovery of the patient’s various physiological functions and the lower the probability of sequelae. , the lesser the degree. The treatment experience of Mrs. Gu, a 71-year-old patient, is the “best endorsement” for the “super early rehabilitation intervention”.
One morning in the midsummer of this year, Mrs. Gu suffered from sudden weakness in her right limb and was unable to walk independently. She came to the emergency department of the Tenth Hospital and was diagnosed with cerebral infarction, so she was treated with thrombolysis. That afternoon, when she returned to the neurology ward, she was evaluated by a rehabilitation doctor, who showed that her right limb function score was poor.
Rehabilitation doctors and therapists formulated a personalized rehabilitation plan based on the evaluation results and her personal wishes, including comprehensive training of hemiplegic limbs, joint mobilization training, low-to-medium frequency pulsed electric therapy, air pressure therapy, and transcranial repetitive magnetic stimulation therapy. One week later, she was able to walk independently indoors, and the Fugl-meyer assessment of upper and lower extremity motor function increased from 46 points at the beginning of the onset to 67 points.
As early as 2017, the Stroke Center of the Tenth Hospital established a rehabilitation treatment team led by head nurse Jin Aiping. The team was participated by rehabilitation and nursing staff, and used high-end rehabilitation equipment such as rehabilitation robots to apply the theoretical methods of big data to the field of neurorehabilitation. To provide rehabilitation means more suitable for the pathophysiological characteristics of stroke patients. In addition, the center has established the only stroke follow-up clinic in Shanghai. Case managers complete follow-up visits for more than 2,000 patients per year, with a total follow-up of 12,000 people and 1,000 people in the library, establishing a new model of stroke follow-up.
At present, 100% of the patients treated in the stroke center of the 10th hospital receive ultra-early rehabilitation intervention within 24 hours of onset, and the functional improvement rate of patients has increased from 40% to 70%, which greatly maintains the quality of life of patients and reduces the care burden of family members.
Extend the “golden treatment period” of patients
The traditional “golden treatment period” of thrombolysis is within 6 hours of onset. However, due to differences in the degree of attention, personal feelings, and traffic conditions, some patients may have been onset for more than 6 hours when they come to the hospital. For them, is it no choice but to accept conservative treatment? In Shanghai Tenth Academy, the answer is no.
In August this year, by optimizing and integrating resources, the Tenth Hospital established the city’s first stroke thrombectomy center, dedicated to enabling patients to receive more precise treatment through specialized teams, special inspections, and professional evaluations. Based on clinical observation and research with a large sample size, the center proposed a new “golden treatment period” – which can be extended to within 24 hours after the onset of the disease under certain conditions. Mr. Zhang is the beneficiary of this new time window.
One morning at 6 o’clock in the morning, Mr. Zhang, who was confused, was sent to the emergency room of the Tenth Hospital by his family. After careful consultation, the visiting doctor determined that the onset time was 10 o’clock the night before, and the onset had been more than 8 hours. However, the receiving doctor did not give up. Immediately after admission, Mr. Zhang was arranged for a multimodal CT examination, and it was found that there were still large areas of low-perfusion brain tissue that were not completely necrotic.
Zhang Quanbin, director of the stroke center, made a decisive decision and decided to carry out thrombectomy. After the operation, Mr. Zhang recovered completely and was able to walk on the ground when he was discharged from the hospital.
Adhering to the concept and scientific spirit of “people first, life first”, the “Ten Hospitals Model” for stroke treatment in the future will continue to improve and optimize the stroke treatment system, anchoring the goal of a healthy Shanghai and a healthy China.