急性缺血性卒中静脉溶栓护理路径优化研究

Study on optimization of nursing pathway of intravenous thrombolysis in acute ischemic stroke

目的优化急性缺血性卒中(AIS)急诊静脉溶栓护理路径来减少绿色通道院内延误。方法分析我科实施AIS急诊静脉溶栓护理路径前后患者从到达急诊至静脉使用重组组织型纤溶酶原激活物(rt-PA)的时间(DNT)和疗效。结果28例静脉溶栓患者年龄、性别、既往史及溶栓前美国国立卫生研究院卒中量表(NIHSS)分数等基线匹配良好,组间具有可比性;观察组DNT有下降趋势、DNT≤60min增加至3例;治疗后第7天,25例存活患者NIHSS分数与治疗前比较差异有统计学意义(Z=-3.779,P<0.01);治疗后第7天,观察组溶栓后存活患者NIHSS减分值与对照组比较差异无统计学意义(Z=-1.819,P=0.069)。结论 AIS急诊静脉溶栓护理路径进一步减少院内延误;急诊室静脉溶栓治疗后神经功能缺损症状改善,应紧跟国内外指南,严格把握溶栓适应证,加强溶栓前后护理工作。

Objective To optimize the nursing pathway of acute ischemic stroke （AIS） and reduce the hospital delay in the green channel.Methods To evaluate whether improving emergency intravenous thrombolysis nursing pathway of AIS can impact the curative effect and the door-to-needle time （DNT）, the time required when acute ischemic stroke patients have been hospitalised to be treated by recombinant tissue plasminogen activator （rt-PA）.Results The baseline of the age, gender, major past history and NIHSS score before thrombolysis of 28 patients was well matched, and the groups were comparable.DNT decreased in the experimental group and the time less than 60min increased to 3 cases.Ontheseventhdayaftertreatment, therewassignificantdifferencein NIHSS score between the 25 surviving patients before and after treatment （Z=-3.779, P〈0.01）, and there was no significant difference in the NIHSS score between the patients in the experimental group and the control group （Z=-1.819, P=0.069）.Conclusion Emergency intravenous thrombolysis nursing pathway of AIS do reduce the hospital delay.The improvement of neurological deficit after intravenous thrombolytic therapy in emergency room should follow the guidelines both here and abroad, strictly grasp the indications of thrombolysis, and strengthen nursing care before and after thrombolytic therapy.