绿道专职护士主导的急性缺血性脑卒中静脉溶栓救治模式的应用

Effect of intravenous thrombolytic therapy mode on patients with acute ischemic stroke led by fast-track specialist nurses

目的探讨绿道专职护士主导的急性缺血性脑卒中(acute ischemic stroke,AIS)溶栓救治模式的应用效果。方法选取2021年3月—2023年2月深圳市某三级甲等综合医院急诊科收治的124例AIS静脉溶栓治疗患者为研究对象。其中2021年3月—2022年2月61例AIS患者为对照组,采用常规救治模式接诊溶栓;2022年3月—2023年2月的63例AIS患者为干预组,采用以绿道专职护士为主导的模式接诊溶栓。比较两组患者入院至完成CT所用时间、溶栓知情同意谈话时间、入院至静脉溶栓开始时间(door to needle time,DNT)、DNT 60min达标率、溶栓前后美国国立卫生院卒中量表(national institute of health stroke scale,NIHSS)评分及患者就诊满意度。结果干预组入院至完成CT检查所用时间、溶栓知情同意谈话时间、DNT均短于对照组,干预组DNT 60min达标率高于对照组,溶栓前后干预组NIHSS评分降幅较对照组大,两组比较,差异具有统计学意义(均P<0.05)。干预组患者就诊满意度高于对照组,两组比较,差异具有统计学意义(P<0.05)。结论以绿道专职护士为主导的AIS静脉溶栓救治模式可有效缩短患者入院至完成CT检查所用时间、溶栓知情同意谈话时间、DNT时间,降低患者NIHSS评分,提高DNT 60 min达标率及患者就诊满意度。

Objective To investigate the effectiveness of intravenous thrombolytic therapy mode led by fast-track specialist nurses on patients with acute ischemic stroke(AIS).Methods This study involved 124 AIS patients who underwent intravenous thrombolytic therapy in the Department of Emergency of our hospital from March 2021 to February 2023.Among the patients,61 admitted between March 2021 and February 2022 received conventional AIS thrombolytic therapy were assigned to a control group.While the 63 patients who received AIS thrombolytic therapy under the specialist nurse-led intravenous thrombolytic therapy mode between March 2022 and February 2023 were assigned to an observation group.The two groups were compared in terms of the time from admission to completion of CT examination,time for signing the informed consent for thrombolytic therapy,door to needle time and percentage of DTN<60 minutes,as well as the post-thrombolysis scores according to the National Institute of Health Stroke Scale(NIHSS)and satisfaction to medical consultation.Results The observation group exhibited a significantly shorter time from admission to completion of CT examination,a shorter time for signing an informed consent for thrombolytic therapy,a shorter door to needle time and a higher percentage of DTN<60 minutes,all with significant difference in comparison with those in the control group.After thrombolysis,the NIHSS score of the observation group decreased more than that of the control group(P<0.05).The patients and their families in the observation group reported significantly higher satisfaction compared to those in the control group(both P<0.05).Conclusion The fast-track specialist nurse-led intravenous thrombolytic therapy mode demonstrates the superiority in reduction of the time from admission to completion of CT examination,time for signing an informed consent for thrombolytic therapy,door to needle time and the NIHSS scores,higher percentage of DTN<60 minutes as well as improvement of patient satisfaction.