基于时效分析的以护士为媒介的急诊溶栓临床护理路径的构建及应用 Construction and Application of Optimized Clinical Nursing Pathway of Acute Thrombolytic Therapy during Treatment of Patients with Acute Ischemic Stroke based on Time-dependent Analysis

Abstract

目的 构建适用于急性缺血性卒中（acute i schemic s troke，AIS）患者急诊溶栓的临床护理路径 （clinical nursing pathway，CNP），并探讨其在急诊救治中的可行性及实施效果。 方法 通过查阅文献、病例回顾及对急诊科医护人员的质性访谈等方法构建AIS患者急诊溶栓CNP， 并对AIS患者在急诊抢救室内实施急诊溶栓CNP干预，比较试验组和对照组患者救治的时间节点、治疗效果的差异。 结果 比较两组的护理时效指标，结果发现试验组患者在接诊-计算机断层扫描（computed tomography，CT）检查、CT报告-给药及入院至静脉溶栓门-针时间（door to needle time，DNT）3个时效指标显著优于对照组，比较差异有统计学意义（P＜0.05）。 结论 对AIS患者提供优化的急诊溶栓CNP可有效缩短患者救治时间，改善患者预后，值得临床推广应用。 Abstract: Objective To establish a clinical nursing pathway of acute thrombolytic therapy during treatment of patients with acute ischemic stroke (AIS) in emergency room, and to investigate its feasibility and effects. Methods The clinical nursing pathway of acute thrombolytic therapy in AIS patients were established by consulting literatures, case review and qualitative interviews with emergency department medical staff. Nursing intervention was performed on patients with AIS during acute thrombolytic therapy in emergency room. Treatment time points and therapeutic effects were compared between the experimental group and the control group. Results There were statistical differences in three timing indexes between two groups (P <0.05). They were receiving new patients to computed tomography (CT) scan time, CT results to needle time and door to needle time, which were obvious better in experimental group than the control group. Conclusion Optimized clinical nursing pathway of acute thrombolytic therapy can reduce treatment time of patients with AIS and improve prognosis, which is worthwhile to be promoted.

Keywords

• 急诊溶栓治疗
• 临床护理路径
• 急性缺血性卒中
• acute thrombolytic therapy
• clinical nursing pathway
• acute ischemic stroke