Effect of evidence-based clinical nursing pathway on emergency thrombolytic therapy in patients with acute cerebral infarction
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摘要:
目的 急性脑梗死(ACI)具有较高致残率和致死率，为了提高ACI患者护理质量，本研究应用基于循证的临床护理路径，分析其护理效果。 方法 选取2018年5月—2020年4月嵊州市中医院急诊收治的126例急性脑梗死患者，患者均行急诊溶栓治疗，根据随机数字表法将患者分为对照组及观察组，每组63例。2组患者均给予常规护理模式辅助治疗干预，在此基础上观察组应用基于循证理论的临床护理路径。比较2组患者溶栓护理时效指标(院前救治时间、入院-医嘱下达用时、检查用时、入院至开始静脉溶栓的用时及总用时)、护理前后神经功能[脑卒中量表(NIHSS)]及日常活动能力(Barthel指数)，统计2组患者护理满意度。 结果 观察组溶栓时效各项指标均短于对照组(均P < 0.05)；护理后，观察组神经功能及日常活动能力均优于对照组(均P < 0.05)；观察组患者护理满意度为98.4%(62/63)，高于对照组的76.2%(48/63)，2组差异有统计学意义(P < 0.05)。 结论 构建基于循证理论的临床护理路径干预模式可缩短急性脑梗死患者救治时间，在常规治疗和护理的基础上能明显改善患者神经功能及日常生活能力。 Abstract:Objective Acute cerebral infarction (ACI) has high disability and mortality rates. To improve the nursing quality of patients with ACI, this study used an evidence-based clinical nursing pathway and analysed its effect. Methods A total of 126 patients with ACI who received emergency Emergency thrombolytic therapy in Shengzhou Hospital of Traditional Chinese Medicine from May 2018 to April 2020 were selected with a convenience sampling method. With a stochastic digital meter, the patients were divided into control and observation groups (n=63). Both groups of patients received the conventional nursing mode of adjuvant treatment intervention. The observation group recieved addtional emergency thrombolytic therapy according to the evidence-based theory of clinical nursing path. The efficacy indexes of thrombolytic nursing (pre-hospital treatment time, The time from admission to doctor orders, examination time, DNT time and total time), neurological function [stroke scale (NIHSS)] and daily activity ability (Barthel index) before and after nursing were compared between the 2 groups, and the nursing satisfaction of patients in the 2 groups was statistically analysed. Results All the indicators of the thrombolysis time effect in the observation group was shorter than those in the control group (P < 0.05). After nursing, nerve function and ability to conduct daily activities in the observation group were higher than those in the control group, and the nursing satisfaction level of the observation was 98.4% (62/63), superior than 76.2% (48/63, P < 0.05). Conclusion A clinical nursing path intervention mode based on an evidence-based theory can shorten treatment time for patients with ACI on the basis of routine treatment and nursing, the neurological function and daily nerve function and daily life ability of patients and provide a reference for clinical nursing. -
表 1 2组急性脑梗死患者溶栓护理时效相关指标比较(x ±s，min)
组别 例数 院前救治时间 入院-医嘱下达用时 检查用时 DNT用时 总用时 对照组 63 5.67±0.46 5.28±1.27 11.45±2.63 57.44±12.41 82.38±14.52 观察组 63 4.13±0.55 4.26±1.43 8.17±1.42 49.70±15.94 64.37±11.42 t值 17.048 4.233 8.710 3.041 7.738 P值 ＜0.001 ＜0.001 ＜0.001 0.003 ＜0.001 
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表 2 2组急性脑梗死患者护理前后神经功能及日常生活能力比较(x ±s)
组别 例数 NIHSS（分） t值 P值 Barthel指数 t值 P值 干预前 干预后 干预前 干预后 对照组 63 36.42±4.11 19.48±3.11 26.088 ＜0.001 50.26±5.58 72.62±5.27 23.123 ＜0.001 观察组 63 36.48±3.97 13.25±3.25 35.938 ＜0.001 50.27±5.63 76.51±5.33 26.864 ＜0.001 t值 0.083 10.993 0.010 4.119 P值 0.934 ＜0.001 0.992 ＜0.001
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表 3 2组急性脑梗死患者护理满意度比较[例(%)]
组别 例数 非常满意 满意 一般 不满意 护理满意度 对照组 63 25（39.7） 23（36.5） 10（15.9） 5（7.9） 48（76.2） 观察组 63 38（60.3） 24（38.1） 1（1.6） 0（0.0） 62（98.4） 注：2组护理满意度比较，χ2=13.040，P＜0.001。
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