急性缺血性脑卒中患者静脉溶栓治疗中卒中护士的临床意义。
Clinical significance of stroke nurse in patients with acute ischemic stroke receiving intravenous thrombolysis.
机构信息
Department of Neurology, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China.
出版信息
BMC Neurol. 2021 Sep 16;21(1):359. doi: 10.1186/s12883-021-02375-6.
BACKGROUND
Reports have proven that shorter door-to-needle time (DTN time) indicates better outcomes in AIS patients received intravenous thrombolysis. Efforts have been made by hospitals and centers to minimize DTN time in many ways including introducing a stroke nurse. However, there are few studies to discuss the specific effect of stroke nurse on patients' prognosis. This study aimed to compare consecutive AIS patients before and after the intervention to analyze the effect of stroke nurse on clinical outcome of AIS patients.
METHODS
In this retrospective study, we observed 1003 patients from November 2016 to December 2020 dividing in two groups, collected and analyzed AIS patients' medical history, clinical assessment information, important timelines, 90 mRS score, etc. Comparative analysis and mediation analysis were also used in this study.
RESULTS
A total of 418 patients was included in this study, and 199 patients were enrolled in the stroke nurse group and 219 was in the preintervention group. Baseline characteristics of patients showed no significant difference except there seems more patients with previous ischemic stroke history in the group of stroke nurse. (p = 0.008). The median DTN time significantly decreased in the stroke nurse group (25 min versus 36 min, p < 0.001) and multivariate logistic regression analysis showed the 90-day mRS clinical outcome significantly improved in the stroke nurse group (p = 0.001). Mediation analysis indicated the reduction of DTN time plays a partial role on the 90 days mRS score and the stroke nurse has some direct effect on the improvement of clinical outcome (p = 0.006).
CONCLUSIONS
The introduction of stroke nurse is beneficial to clinical outcome of AIS patients and can be use of reference in other hospitals or centers.
背景
有报道证实，急性缺血性脑卒中（AIS）患者接受静脉溶栓治疗时，门到针时间（DTN 时间）越短，预后越好。医院和中心已通过多种方式努力将 DTN 时间最小化，包括引入脑卒中护士。然而，很少有研究探讨脑卒中护士对患者预后的具体影响。本研究旨在通过比较干预前后连续的 AIS 患者，分析脑卒中护士对 AIS 患者临床结局的影响。
方法
本回顾性研究观察了 2016 年 11 月至 2020 年 12 月期间的 1003 例 AIS 患者，将其分为两组，收集和分析 AIS 患者的病史、临床评估信息、重要时间线、90 天 mRS 评分等。本研究还进行了对比分析和中介分析。
结果
本研究共纳入 418 例患者，其中 199 例患者纳入脑卒中护士组，219 例患者纳入干预前组。两组患者的基线特征无显著差异，除脑卒中护士组既往有缺血性脑卒中史的患者似乎更多（p=0.008）。脑卒中护士组的中位 DTN 时间明显缩短（25 分钟比 36 分钟，p<0.001），多变量逻辑回归分析显示脑卒中护士组 90 天 mRS 临床结局显著改善（p=0.001）。中介分析表明，DTN 时间的缩短对 90 天 mRS 评分有部分作用，而脑卒中护士对临床结局的改善有一定的直接作用（p=0.006）。
结论
引入脑卒中护士有利于 AIS 患者的临床结局，可为其他医院或中心提供参考。
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