Kummarg Urai, Sindhu Siriorn, Muengtaweepongsa Sombat
Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand.
Faculty of Nursing, Mahidol University, Bangkok 10700, Thailand.
Neurol Res Int. 2018 Jun 7;2018:1717843. doi: 10.1155/2018/1717843. eCollection 2018.
Intravenous recombinant tissue plasminogen activator (i.v. rt-PA) is the milestone treatment for patients with acute ischemic stroke. Stroke Fast Track (SFT) facilitates time reduction, guarantees safety, and promotes good clinical outcomes in i.v. rt-PA treatment. Nursing case management is a healthcare service providing clinical benefits in many specific diseases. The knowledge about the efficacy of a nurse case management for Stroke Fast Track is limited. We aim to study the effect of nurse case management on clinical outcomes in patients with acute ischemic stroke involving intravenous recombinant tissue plasminogen activator (i.v. rt-PA) treatment.
Seventy-six patients with acute ischemic stroke who received i.v. rt-PA treatment under Stroke Fast Track protocol of Thammasat University Hospital were randomized into two groups. One group was assigned to get standard care (control) while another group was assigned to get standard care under a nurse case management. The National Institute of Health Stroke Scale (NIHSS) at 24 hours after treatment between the control and the experimental groups was evaluated.
Time from triage to treatment in the experimental group was significantly faster than in the control group (mean = 39.02 and 59.37 minutes, respectively; p=.001). The NIHSS at 24 hours after treatment in the nurse case management group was significantly improved as compared to the control group (p=.001). No symptomatic intracranial hemorrhage (sICH) was detected at 24 hours after onset in both groups.
The nurse case management should provide some benefits in the acute stroke system. Although the early benefit is demonstrated in our study, further studies are needed to ensure the long-term benefit and confirm its profit in patients with acute ischemic stroke.
静脉注射重组组织型纤溶酶原激活剂（i.v. rt-PA）是急性缺血性脑卒中患者的里程碑式治疗方法。卒中快速通道（SFT）有助于缩短时间、保证安全并促进i.v. rt-PA治疗取得良好的临床效果。护理病例管理是一种在许多特定疾病中具有临床益处的医疗服务。关于卒中快速通道护理病例管理效果的知识有限。我们旨在研究护理病例管理对接受静脉注射重组组织型纤溶酶原激活剂（i.v. rt-PA）治疗的急性缺血性脑卒中患者临床结局的影响。
76例在泰国国立法政大学医院卒中快速通道方案下接受i.v. rt-PA治疗的急性缺血性脑卒中患者被随机分为两组。一组接受标准护理（对照组），另一组在护理病例管理下接受标准护理。评估对照组和实验组治疗后24小时的美国国立卫生研究院卒中量表（NIHSS）。
实验组从分诊到治疗的时间明显快于对照组（分别为平均39.02分钟和59.37分钟；p = 0.001）。与对照组相比，护理病例管理组治疗后24小时的NIHSS有显著改善（p = 0.001）。两组在发病后24小时均未检测到症状性颅内出血（sICH）。
护理病例管理在急性卒中系统中应具有一定益处。尽管我们的研究证明了早期益处，但仍需要进一步研究以确保长期益处并证实其对急性缺血性脑卒中患者的益处。
