Zhongguo cuzhong zazhi (May 2018)
卒中急救护士对急性缺血性卒中救治效率的影响 Impact of Stroke Nurses on Treatment Efficiency of Acute Ischemic Stroke
Abstract
目的 探索优化急性缺血性卒中急诊诊疗流程，在预检台设置卒中护士作为第一反应者并贯穿整个 溶栓和血管内取栓绿色通道对治疗效率的影响。 方法 回顾性分析上海长海医院脑血管病中心2016年4月1日-2017年3月31日溶栓和（或）血管内治 疗的急性缺血性卒中病例208例。根据有无卒中护士的参与分为有卒中护士组（43例）和无卒中护士 组（165例）。比较两组各治疗环节的延误时间：进门到用药时间（door-to-needle，DTN）、进门至影像学 检查时间（door-to-imaging，DTI）、影像学检查至用药时间（imaging-to-needle，ITN）、影像学检查至股动 脉穿刺时间（i magi ng-to-puncture，ITP）、进门至股动脉穿刺时间（door-to-puncture，DTP）、到院至治疗 达标率（DTN≤60 min、DTP≤90 min）和出院时及发病3个月预后良好[改良Rankin量表（modified Rankin Scale，mRS）≤2分]的比例。 结果 较无护士组，有卒中护士组DTN中位数由39 mi n缩短至27 mi n（Z =-5.422，P＜0.001）；DTP 中位数由105 mi n缩短至68 mi n（Z =-2.707，P =0.007）；I TN中位数由21 mi n缩短至8 mi n（Z =-5.981，P ＜0.001）；I TP中位数由78.5 mi n缩短至45 mi n（P =0.013）。有护士组和无护士组DTN达标率分别为 97.67%和90.97%（P＜0.001），DTP达标率分别为100%和35.62%（P＜0.001）。出院时和发病3个月有 卒中护士组mRS评分≤2分比例显著高于无卒中护士组（62.79% vs 49.09%；69.77% vs 50.91%，均 P＜0.001）。 结论 急诊预检台设置卒中护士作为第一反应者并贯穿整个急性缺血性卒中溶栓或血管内治疗绿 色通道可以显著缩短急性缺血性卒中患者的DTN时间和ITP时间，提高到院至治疗达标率，改善患者 的预后。 Abstract: Objective To explore how to optimize the emergency diagnosis and treatment working flow for acute ischemic stroke and the impact of nurse on treatment efficiency when nurses were taken as the first responder at the emergency preview platform and involved in the whole process of thrombolysis and thrombectomy green channel. Methods A total of consecutive 208 cases having completed thrombolysis and/or endovascular treatment of acute cerebral infarction in stroke center of Changhai hospital from April 1 2016 to March 31 2017 were analyzed retrospectively. The patients were divided into stroke nurses group (43 cases) and no stroke nurses group (165 cases). The in-hospital time delay of the two groups were compared including door-to-needle (DTN), door-to-imaging (DTI), imaging-to-needle (ITN),imaging-to-puncture (ITP), door-to-puncture (DTP), the rate of reaching standard (DTN≤60 min, DTP≤90 min) and the rate of modified Rankin score (mRS)≤2. Results The median of DTN was reduced from 39 minute to 27 minute after the involvement of stroke nurses (Z =-5.422, P <0.001); the median of DTP was reduced from 105 minute to 68 minute (Z=-2.707, P =0.007); the median of ITN was reduced from 21 minute to 8 minute (Z=-5.981, P <0.001); the median of ITP was reduced from 78.5 minute to 45 minute (P =0.013). The rate of reaching the standard of DTN 60 min were different (97.67% vs 90.97%, P <0.001). The rate of reaching the standard of DTP 90 min were different (100% vs 35.62%, P <0.001). The rate of mRS ≤2 in stroke nurse group was significantly higher than that in no stroke nurse group at discharge and 3 months (62.79% vs 49.09%; 69.77% vs 50.91%, all P <0.001). Conclusion The stroke nurses taken as the first responders at the emergency preview platform and involving the entire Green Channel can significantly shorten the DTN and ITP time in thrombolysis in acute stroke patients with DTN and ITP time, increase the rescue efficiency, and improve the prognosis of patients.
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