新型标准化护理协作工作流程可减少急性缺血性脑卒中患者的溶栓延迟
New standardized nursing cooperation workflow to reduce stroke thrombolysis delays in patients with acute ischemic stroke.
作者信息
Zhou Yan, Xu Zhuojun, Liao Jiali, Feng Fangming, Men Lai, Xu Li, He Yanan, Li Gang
机构信息
Nursing Department, Shanghai East Hospital, Tongji University School of Medicine, Shanghai.
Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
出版信息
Neuropsychiatr Dis Treat. 2017 May 9;13:1215-1220. doi: 10.2147/NDT.S128740. eCollection 2017.
OBJECTIVE
We assessed the effectiveness of a new standardized nursing cooperation workflow in patients with acute ischemic stroke (AIS) to reduce stroke thrombolysis delays.
PATIENTS AND METHODS
AIS patients receiving conventional thrombolysis treatment from March to September 2015 were included in the control group, referred to as T0. The intervention group, referred to as T1 group, consisted of AIS patients receiving a new standardized nursing cooperation workflow for intravenous thrombolysis (IVT) at the emergency department of Shanghai East Hospital (Shanghai, People's Republic of China) from October 2015 to March 2016. Information was collected on the following therapeutic techniques used: application or not of thrombolysis, computed tomography (CT) time, and door-to-needle (DTN) time. A nursing coordinator who helped patients fulfill the medical examinations and diagnosis was appointed to T1 group. In addition, a nurse was sent immediately from the stroke unit to the emergency department to aid the thrombolysis treatment.
RESULTS
The average value of the door-to-CT initiation time was 38.67±5.21 min in the T0 group, whereas it was 14.39±4.35 min in the T1 group; the average values of CT completion-to-needle time were 55.06±4.82 and 30.26±3.66 min; the average values of DTN time were 100.43±6.05 and 55.68±3.62 min, respectively; thrombolysis time was improved from 12.8% (88/689) in the T0 group to 32.5% (231/712) in the T1 group (all <0.01). In addition, the new standardized nursing cooperation workflow decreased the National Institutes of Health Stroke Scale (NIHSS) scores at 24 h (<0.01) (T0: prethrombolysis, 6.97±3.98; 24 h postthrombolysis, 3.33±2.09; 2 weeks postthrombolysis, 2.25±1.01 and T1: prethrombolysis, 7.00±3.89; 24 h postthrombolysis, 2.60±1.66; 2 weeks postthrombolysis, 2.21±1.02).
CONCLUSION
The new standardized nursing cooperation workflow reduced stroke thrombolysis delays in patients with AIS.
目的
我们评估了一种新的标准化护理协作流程对急性缺血性卒中（AIS）患者减少卒中溶栓延迟的有效性。
患者与方法
2015年3月至9月接受传统溶栓治疗的AIS患者纳入对照组，称为T0组。干预组，即T1组，由2015年10月至2016年3月在上海东方医院急诊科接受静脉溶栓（IVT）新标准化护理协作流程的AIS患者组成。收集以下使用的治疗技术信息：是否应用溶栓、计算机断层扫描（CT）时间和门到针（DTN）时间。T1组指定一名护理协调员帮助患者完成医学检查和诊断。此外，立即从中风单元派遣一名护士到急诊科协助溶栓治疗。
结果
T0组门到CT启动时间的平均值为38.67±5.21分钟，而T1组为14.39±4.35分钟；CT完成到针时间的平均值分别为55.06±4.82和30.26±3.66分钟；DTN时间的平均值分别为100.43±6.05和55.68±3.62分钟；溶栓时间从T0组的12.8%（88/689）提高到T1组的32.5%（231/712）（均<0.01）。此外，新的标准化护理协作流程在24小时时降低了美国国立卫生研究院卒中量表（NIHSS）评分（<0.01）（T0组：溶栓前，6.97±3.98；溶栓后24小时，3.33±2.09；溶栓后2周，2.25±1.01；T1组：溶栓前，7.00±3.89；溶栓后24小时，2.60±1.66；溶栓后2周，2.21±1.02）。
结论
新的标准化护理协作流程减少了AIS患者的卒中溶栓延迟。
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