标准化诊疗护理流程对急性缺血性卒中rt-PA静脉溶栓疗效的影响

Effect of standardized nursing process on the efficacy of intravenous thrombolysis with rt-PA in patients with acute ischemic stroke

目的探讨标准化诊疗护理流程在静脉溶栓过程中的疗效和影响。方法纳入2015年1月至2016年10月十堰市郧阳区中医院收治的急性缺血性卒中(Acute ischemic stroke,AIS)患者46例为观察组。另回顾性纳入2012年2月至2014年12月收治的AIS患者42例设为对照组。对照组患者采用常规诊疗护理措施,观察组采用静脉溶栓标准化诊疗护理流程。观察和记录两组溶栓病例数、急诊各环节时间、溶栓后各时点神经功能缺损及日常生活活动能力情况,并进行比较。结果观察组46例,溶栓34例,溶栓率73.9%,对照组42例,溶栓22例,溶栓率52.4%,两组比较溶栓率有统计学差异(P<0.05)。观察组各环节时间(医师到位时间、急诊至影像学时间、影像时间、检验结果回报时间、患者到医院至开始静脉溶栓时间等)均明显短于对照组(P<0.05);两组溶栓后NIHSS评分、Barthel指数较前均有改善,有统计学差异(P<0.05),但观察组的改善程度更显著,差异有统计学意义(均P<0.05)。结论对AIS患者静脉溶栓治疗,采用标准化诊疗护理流程,可缩短静脉溶栓时间,提高溶栓率及疗效。

Objectives To discuss the efficacy and influence of standardized nursing care in the process of intravenous thrombol- ysis. Methods The observation group（ n =46） were composed of the Acute ischemic stroke（AIS） patients admitted to the hospital of Yunyang District of the city of Shiyan from January 2015 to October 2016. The control group （n = 42） were retrospectively ana- lyzed the AIS patients admitted to the hospital from February 2012 to December 2014. Patients in the control group were treated with routine nursing care, while the observation group was treated with standardized diagnosis and nursing process of intravenous thrombo- lytic. To observe and record the number of cases of thrombolysis,the time of each link in the emergency department, the neurological deficits and activities of daily living in two groups after thrombolysis, and compare them. Results The rate of thrombolysis was 73.9% （34 cases has the thrombolysis） among the 46 cases in observation group. The rate of thrombolysis was 52. 4% （22 cases has the thrombolysis） among the 42 cases in control group. The difference between the two groups was statistically significant （ P 〈 O. 05 ）. The observation group each link time （ such as, physicians in place of time, emergency physicians to imaging time, imaging time,return time of the inspecting and the time from patients arriving at the hospital to start intravenous thrombolysis time （DNT）, were significantly shorter than the control group （ P 〈 0. 05 ）. The NIHSS score, Barthel index were improved after thrombolysis among the two groups, and there were significant differences （P 〈 0. 05 ）. However, the improvement is more obviously in the observation group, the difference was statistically significant （ P 〈 O. 05 ）. Conclusion Adoptted the standardized diagnosis and nursing process for the AIS patients＇ intravenous thrombolytic, may shorten the DNT and improve the thrombolytic rate and efficacy.