Analiza ključnih pitanja organizacije hitnog zbrinjavanja oboljelih od moždanog i srčanog udara u Bjelovarsko-bilogorskoj županiji

Abstract

Emergency care for patients with acute ischemic stroke and acute myocardial infarction according to the principles of evidence-based medicine is a challenge for the healthcare system, as it requires a multidisciplinary approach and good cooperation of all the subjects involved. The time elapsed from symptom onset to patient admission to the hospital, and the period from admission to the hospital to the beginning of therapy play an essential role in the thrombolytic treatment of stroke. For the patient, effective functioning of the system can mean the difference between preserved functional independence and disability. In recent years in Bjelovar-Bilogora County, there has been some development in emergency care of patients with acute heart attack by applying thrombolytic therapy and organizing transfer of indicated cases to the nearest clinical department for invasive cardiologic therapy. In case of acute ischemic stroke, thrombolysis has so far remained the only method of causal treatment. Results of a retrospective study conducted in 2010 in Bjelovar General Hospital on 169 patients with the established time of ischemic stroke symptom onset showed that only 39.64% of patients reached the hospital for treatment within the target time window. The results indicated the need for continuous efforts in preventing cardiovascular and cerebrovascular disease, as well as for education of citizens and healthcare professionals in recognizing the early symptoms of stroke and understanding them as an emergency condition. The present situation calls for permanent education of health workers in first line contact, an increase in the number of neurologists and cardiologists, as well as the introduction of stroke units on the model of coronary units, with constant presence of specialists. The radiology and laboratory services need adjustment to enable performing diagnostic procedures within the given time limit. At the national level, a network of stroke units should be organized, which would eliminate distance to county hospitals as a limiting factor in effective treatment.Hitno zbrinjavanje oboljelih od akutnog infarkta miokarda i akutnog ishemijskog moždanog udara prema načelima medicine temeljene na dokazima izazov je za zdravstveni sustav, zahtijeva multidisciplinarni pristup i dobru suradnju svih uključenih subjekata. U trombolitičkom liječenju moždanog udara ključna je uloga vremena proteklog od nastanka simptoma do dolaska u bolnicu i vremena od dolaska u bolnicu do početka terapije. U posljednjih nekoliko godina na području Bjelovarsko-bilogorske županije postignut je napredak u zbrinjavanju bolesnika s akutnim srčanim udarom primjenom trombolitičke terapije i organizacijom premještaja indiciranih slučajeva u najbližu kliniku radi invazivne kardiološke terapije, a u slučajevima akutnog ishemijskog moždanog udara tromboliza zasad ostaje jedina metoda kauzalnog liječenja. Rezultati retrospektivne studije koju smo proveli 2010. godine u Općoj bolnici Bjelovar na 169 bolesnika s poznatim vremenom nastanka simptoma ishemijskog moždanog udara pokazali su da je samo 39,64% oboljelih stiglo na liječenje u bolnicu u ciljnom vremenskom okviru. Zaključujemo da je i dalje potrebno raditi na obrazovanju stanovništva o čimbenicima rizika, promjeni načina života, te ranom prepoznavanju simptoma bolesti i shvaćanju moždanog i srčanog udara kao hitnog stanja. Neophodna je trajna izobrazba zdravstvenih djelatnika prvog kontakta, povećanje broja specijalista neurologa i kardiologa, organiziranje jedinice za moždani udar po uzoru na koronarne jedinice uza stalno prisutne liječnike specijaliste, te prilagodba radiološke i laboratorijske djelatnosti za provedbu dijagnostike u zadanim vremenskim okvirima. Na nacionalnoj razini potrebna je organizacija mreže jedinica za moždani udar, čime bi prostorna udaljenost od županijske bolnice prestala biti ograničavajući čimbenik u djelotvornom liječenju