专业护理干预对院内缺血性卒中患者从发现至静脉溶栓用药时间的影响

Effect of professional nursing intervention on the medication time of intravenous thrombolytic therapy in inpatients with ischemic stroke

目的探讨专业护理对院内缺血性卒中患者从发现至静脉溶栓用药时间的影响。方法选取我院2010-2016年发生缺血性卒中并实施重组人组织纤维蛋白溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓的住院患者19例。将其中8例由急诊科和神经科经过溶栓专业培训护士实施静脉溶栓的患者归为专业组,将其余11例在其他科室住院期间发生缺血性卒中,由未经过溶栓培训护士实施rt-PA静脉溶栓的患者归为对照组。分别统计从发现至溶栓治疗时间(find to needle time,FNT)、下达医嘱到溶栓开始时间(preparation to needle time,PNT)以及患者溶栓后90 d的改良Rankin量表(modified Rankin scale,mRS)评分,分别对上述指标进行单因素分析,并通过问卷调查方式分别评估经过溶栓专业培训护士和未经过溶栓培训护士对院内卒中的认知情况。结果单因素分析结果显示,专业组FNT明显短于对照组,差异有统计学意义(P<0.05);专业组PNT明显短于对照组,差异有统计学意义(P<0.05);2组患者溶栓治疗后90 d的mRS评分无明显差异(P>0.05);经过溶栓专业培训的护士对院内卒中的认知程度明显高于未经过溶栓培训的护士。结论急诊和神经科病区院内卒中的FNT明显短于其他科室;经过正规溶栓培训的护士可以缩短院内卒中FNT。

Objective To investigate the effect of professional nursing intervention on the medication time of intravenous thrombolytic therapy in inpatients with ischemic stroke. Methods Selected for the study were 19 cases of ischemic stroke that occurred during their stay in the hospital from 2010 to 2016, and they were treated with intravenous thrombolysis of recombinant human tissue plasminogen activator （rt-PA）. Of the 19 cases, 8 cases treated with intravenous thrombolysis implemented by trained professional nurses in the emergency and the neurology departments were assigned as the professional nursing group, the other 11 cases treated with in-travenous thrombolysis of rt-PA implemented by non-professional nurses in other medical departments were assigned as the control group. Statistical analyses were made on the scores of from perceiving to needle time （PNT） , find to needle time （FNT） and the scores of Modified Rankin Scale （MRS） 90 days after thrombolytic therapy, and single-factor analyses were also made on the above indicators. Then, awareness of ischemic stroke perceived respectively by trained professional nurses and non-professional nurses was assessed by the approach of questionnaire. Results Single-factor analyses indicated that PNT of the trained professional nursing group was significantly shorter than that of the control group, and statistical significance could be noticed when comparisons were made between them （P 〈0. 01） . The FNT of the trained professional nursing group was also significantly shorter than that of the control group, and there was no statistical significance when comparisons were made between them（P 〈0. 05） . And there were neither significant differences in mRS scores 90 days after intravenous thrombolytic therapy, when comparisons were made between the 2 groups（P 〈0.05）. The awareness of in-hospital stroke by the professional nursing group was significantly higher than that of the non-professional nursing group. Conclusion The PNT of the in-hospital stroke patients in the emergency and neurological wards was significantly shorter than that of the other departments of the hospital. Nurses with regular thrombolytic therapy training could obviously shorten the time from stroke on-set to thrombolytic therapy.