【目的】Prehospital Stroke Life Support(PSLS)およびImmediate Stroke Life Support(ISLS)を通した当院でのrt-PA静注療法の結果について解析した．【方法】対象は治療を行った連続39例で，治療効果について検討し，PSLS/ISLSを導入する前後で治療開始までに要した時間を比較した．またNIHSSと倉敷病院前脳卒中スケール(KPSS)の相関についても解析した．【結果】rt-PAの有効率は61.5% でmRS 0–1となったものは36% であった．症例数は後期で有意に増加(rt-PA/急性期脳梗塞入院症例：27/208例，13.0%)し，治療までに要した院内時間は後期で有意に減少(前期：93分，後期：76分)し，NIHSS/KPSS間には有意な正の相関(r=0.78)が得られた．【結論】PSLS/ISLSの効果で治療の迅速化と症例数の増加に繋がったものと推察された．
In Japan, practice of cerebral vascular disorder could be grouped into three categories; acute, convalescence and maintenance phase. We introduce the method how we practice the acute phase in our institution. Our basic concept is comprehensive medical care, and to carry out efficient operation, Clinical Pathway (CP) has been introduced since 1999. CP is a multidisciplinary management tool based on evidence-based practice, in which the different tasks by the professionals involved in the patient care are defined. From the point of view of nurses, this enabled to intervene in patients’ early ambulation, preventing complications and preventing disuse syndrome. CP alone is not fully functional for patient care in daily practice since the aim is weighted mainly in treatment, and assistant tool is required to complete this. For example, we use assistant tool such as evaluation sheet of activity of daily life to set the goal of activity in each patient. Final evaluation of patients before discharge is discussed in a conference held once a week participated with doctor, nurse, therapist and medical society worker. In summary, for the treatment of acute phase, training of each professional is important, and team approach is required.
Medical treatment of stroke becomes so complex that medical services are best provided effectively by interdisciplinary team care. Our stroke team is at the forming stage to organize a stroke unite near future. To clarify the present status of stroke care team, we conducted questionnaire survey on team work efficiency in three medical care teams, stroke rehabilitation, heart rehabilitation and breast surgery team. Compared with two other teams, our stroke team members need sharing the clear common vision, effective mutual communication and structure, which enriches each expertise. Team members, moreover, should understand the team process and always make an effort which improves the quality of stroke care by the feedback of outcome indicators.