神经功能恢复为核心的护理模式在急性缺血性脑卒中机械取栓中的应用

Nursing Centered on Neurological Rehabilitation for Patients With Acute Ischemic Stroke After Mechanical Thrombectomy Treatment

目的探讨以神经功能恢复为核心的术后护理模式在急性缺血性脑卒中(acute ischemic stroke,AIS)机械取栓患者中的护理效果。方法2016年1月~2019年6月我们将神经功能恢复为核心的术后护理模式应用于机械取栓治疗36例AIS,评价指标为美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)和改良Rankin量表(modified Rankin Scale,mRS)。结果31例(86.1%)经急诊机械取栓手术成功获得血管再通。术前NIHSS评分(12.6±4.7)分,出院时(5.3±1.5)分,差异有显著性(P<0.05)。5例死亡:2例机械取栓术后24 h出现症状性脑出血死亡;2例颈内动脉近端急性闭塞,血栓负荷量大,分别于术后1、4.5 h出现恶性脑水肿、脑疝死亡;1例术后第5天突发大量蛛网膜下腔出血死亡。出院时mRS评分:0分14例,1分11例,2分5例,3分1例。23例术后90 d门诊随访,由医生进行mRS评分:0分9例,1分9例,2分5例,均为预后良好。结论对于AIS机械取栓患者,以神经功能恢复为核心的术后护理模式能有效降低神经系统并发症发生率,促进患者神经功能康复。

Objective To evaluate the effect of nursing mode centered on functional recovery of nervous system for patients with acute ischemic stroke(AIS)after mechanical thrombectomy treatment.Methods A total of 36 patients’characteristics with AIS treated with mechanical thrombectomy treatment from January 2016 to June 2019 were given postoperative nursing centered on neurological rehabilitation.The National Institutes of Health Stroke Scale(NIHSS)between preoperative and at discharge of the patients and the postoperative modified Rankin Scale(mRS)at discharge were used to evaluate outcomes.Results A total of 31 cases(86.1%)were successfully recanalized by emergency mechanical embolectomy.The pre-operative NIHSS score(12.6±4.7)points and the discharge score(5.3±1.5)points were significantly different(P<0.05).There were 5 fatal cases:2 cases died of symptomatic intracerebral hemorrhage 24 h after mechanical thrombectomy;2 cases developed acute occlusion of the proximal internal carotid artery with a large amount of thrombus load,and died of malignant brain edema and brain hernia 1 and 4.5 h after operation,respectively;1 case died of sudden massive subarachnoid hemorrhage on the 5th day after operation.A total of 23 cases were followed up for 90 days after operation.The mRS scores were scored by doctors:0 in 9 cases,1 points in 9 cases and 2 points in 5 cases.The prognosis was good.Conclusion For patients with AIS after receiving mechanical thrombectomy treatment,the nursing mode centered on functional recovery of nervous system can effectively reduce the incidence of complications and promote the recovery of nervous function.