基于目标的环节式护理在急性脑梗死静脉溶栓联合机械取栓患者中的应用  

Application of target-based segmental nursing in acute cerebral infarction patients treated by intravenous thrombolysis combined with mechanical thrombectomy

作　　者：牟春英[1] 李文文[1] 朱丹丹 柳叶[1] 韩建峰[1] MU Chunying;LI Wenwen;ZHU Dandan;LIU Ye;HAN Jianfeng(The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院,陕西西安710061

出　　处：《中国实用神经疾病杂志》2021年第14期1259-1264,共6页Chinese Journal of Practical Nervous Diseases

基　　金：陕西省重点研发计划项目(编号:2018SF-005)。

摘　　要：目的探索基于目标的环节式护理在急性脑梗死静脉溶栓联合机械取栓治疗患者中的应用效果。方法连续入组2019-01—2020-06收住院的急性脑梗死静脉溶栓联合机械取栓治疗患者98例,干预组和对照组各49例,对照组执行急性脑梗死溶栓取栓常规护理;干预组实施基于目标的环节式护理,即将静脉溶栓桥接取栓的过程按顺序分为5个环节,设立环节护理目标,执行以目标为导向的护理行为。比较2组护理效果及短期预后。结果2组病人护理目标达成情况中溶栓药物外渗率比较差异无统计学意义(48.4%vs 51.6%,P=0.433),入室5 min内静脉溶栓药物使用率(40.5%vs 59.5%,P=0.001)、皮肤黏膜出血率(37.0%vs 63.0%,P=0.004)比较,干预组优于对照组。干预组再灌注损伤(95.0%vs 5.0%,P<0.001)和血管再闭塞(78.6%vs 21.4%,P=0.021)发生率低于对照组;患者出院90 d mRS评分(2.69±3.355 vs 0.96±0.200)和生活自理指数(59.80±39.024 vs 85.3±25.989)比较,干预组均优于对照组(P<0.001)。结论基于目标的环节式护理在急性脑梗死患者静脉溶栓联合机械取栓治疗中能够缩短治疗时间,保证护理质量,同时能够减少并发症及致残率。Objective To explore the application effect of target-based segmental nursing in acute cerebral infarction patients treated by intravenous thrombolysis combined with mechanical thrombectomy.Methods We enrolled 98 patients with acute cerebral infarction treated by intravenous thrombolysis combined with mechanical thrombolysis from January 2019 to June 2020,and they were randomly divided into intervention group and control group.The control group received routine nursing of acute cerebral infarction thrombolysis.The intervention group was given target-based segmental nursing,which divide the process of intravenous thrombolysis bridging thrombolysis into 5 segments in sequence,while the nursing objectives of segments were set and the target-based nursing be⁃haviors were implemented.The nursing effect and short-term prognosis of the two groups were compared.Results In the achieve⁃ment of the nursing targets of patients in both groups,there was no statistical significance in the extravasation rate of thrombolytic drugs between the two groups(48.4%vs 51.6%,P=0.433).In the comparison of intravenous thrombolytic drug utilization rate within 5 minutes of admission(40.5%vs 59.5%,P=0.001),and the skin mucous membrane bleeding rate(37.0%vs 63.0%,P=0.004),the intervention group was better than the control group.The incidence of reperfusion injury(95.0%vs 5.0%,P<0.001)and vascular re-occlusion(78.6%vs 21.4%,P=0.021)were lower in the intervention group than in the control group.After 90 days of discharge,the patients'mRs score(2.69±3.355 vs 0.96±0.200)and living self-care index(59.80±39.024 vs 85.3±25.989)were better in the in⁃tervention group than in the control group(P<0.001).Conclusion The application of target-based segmental nursing in acute cere⁃bral infarction patients treated by intravenous thrombolysis combined with mechanical thrombectomy can shorten the treatment time,and ensure the quality of nursing,while reduce the complication and disability rate of patients.

关 键 词：急性脑梗死 静脉溶栓 机械取栓 环节式护理 并发症 残疾 

分 类 号：R473.74[医药卫生—护理学]