路径化护理方案对急性缺血性脑卒中患者机械取栓的效果

田敏; 谢静; 骆嵩; 叶斌

doi:10.16766/j.cnki.issn.1674-4152.002663

路径化护理方案对急性缺血性脑卒中患者机械取栓的效果

doi: 10.16766/j.cnki.issn.1674-4152.002663

田敏¹,
谢静²,
骆嵩²,
叶斌^1, ,

1.
蚌埠市第三人民医院介入导管室，安徽蚌埠 233000
2.
蚌埠医学院第一附属医院神经内科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究项目 KJ2019A0364

详细信息

通讯作者:
叶斌, E-mail: ye7157@139.com

中图分类号: R473.74 R743.3
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- 文章访问数: 78
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- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-23
- 网络出版日期: 2022-11-29

Effect of pathway nursing program on mechanical thrombectomy in patients with acute ischaemic stroke

TIAN Min¹,
XIE Jing²,
LUO Song²,
YE Bin^{1
, ,}

1.
Catheter Lab Department, the Third People's Hospital of Bengbu, Bengbu, Anhui 233000, China

摘要

摘要: 目的探讨路径化护理方案对急性缺血性脑卒中患者机械取栓的救治效果。方法选取蚌埠市第三人民医院2020年1月—2021年12月急性缺血性脑卒中行机械取栓的患者60例，其中2020年1—12月收治的患者为对照组(30例)，2021年1—12月收治的患者为观察组(30例)。对照组给予常规化护理方案，观察组给予路径化护理方案，比较2组患者的救治效率、血管再通率、并发症发生率、护理满意度及术后90 d改良Ranking量表(MRS)评分。结果观察组静脉溶栓时间、动脉穿刺时间、血运重建时间分别为43.00(30.75, 49.00)min、88.00(82.50, 88.25)min、115.50(109.50, 118.00)min, 对照组为45.50(41.00, 51.25)min、90.50(85.00, 98.50)min、122.50(111.50, 128.25)min，2组比较差异有统计学意义(均P＜0.05);观察组血管再通率(90.0%)高于对照组(66.7%)，差异有统计学意义(χ²=4.812，P=0.028);观察组并发症发生率(30.0%)低于对照组(56.7%)，差异有统计学意义(χ²=4.344，P=0.037);观察组护理满意率为96.7%，对照组为73.3%，差异有统计学意义(χ²=4.706，P=0.030);术后90 d，观察组MRS评分为2.0(1.0, 2.0)分，对照组为2.0(2.0, 3.0)分，2组比较差异有统计学意义(Z=-2.512，P=0.012)。结论路径化护理方案可提高机械取栓患者的救治效果，提升护理满意度。
- 路径化护理方案 /
- 急性缺血性脑卒中 /
- 机械取栓
Abstract: Objective To explore the therapeutic effect of pathway nursing program on mechanical thrombectomy of acute ischaemic stroke patients. Methods A total of 60 patients with mechanical thrombectomy for acute ischaemic stroke from January 2020 to December 2021 in the Third People's Hospital of Bengbu were selected. Amongst them, patients admitted from January 2020 to December 2020 were the control group (30 cases), and patients admitted from January 2021 to December 2021 were the observation group (30 cases). The control group was given a routine nursing program, and the observation group was given a pathway nursing program. The treatment efficiency of patients in the two groups were compared. The rate of vascular recanalisation, incidence of complications, nursing satisfaction, and improved ranking scale (MRS) score 90 d after surgery were compared. Results After giving pathway nursing program treatment, the observation group patients'door-to-needle time, door-to-puncture time and door-to-revascularisation time were 43.00 (30.75, 49.00), 88.00 (82.50, 88.25), and 115.50 (109.50, 118.00) min. These values were shorter than those of the control group with 45.50 (41.00, 51.25), 90.50 (85.00, 98.50), and 122.50 (111.50, 128.25) min, respectively, and the difference were statistically significant (all P < 0.05). The vascular recanalisation rate in the observation group was 90.0%, which was higher than that in the control group (66.7%), and the difference was statistically significant (χ²=4.812, P=0.028). The incidence of complications was 30.0% in the observation group and 56.7% in the control group, and the difference was statistically significant (χ²=4.344, P=0.037). Nursing satisfaction was 96.7% in the observation group and 73.3% in the control group, and the difference was statistically significant (χ²=4.706, P=0.030). The MRS score of the observation group was 2.0 (1.0, 2.0) points at 90 days, lower than that of the control group's 2.0 (2.0, 3.0) points, and the difference was statistically significant (Z=-2.512, P=0.012). Conclusion Pathway nursing program can improve the treatment effect and nursing satisfaction of patients with mechanical thrombectomy.
- Pathway nursing program /
- Acute ischaemic stroke /
- Mechanical thrombectomy

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表 1 2组急性缺血性脑卒中机械取栓治疗患者一般资料比较

Table 1. Comparison of general data between two groups of patients with acute ischemic stroke treated with mechanical thrombectomy

组别	例数	年龄[M(P₂₅, P₇₅)，岁]	性别[例(%)]		发病到院时间(x±s，h)	发病时MRS评分[M(P₂₅, P₇₅)，分]
组别	例数	年龄[M(P₂₅, P₇₅)，岁]	男性	女性	发病到院时间(x±s，h)	发病时MRS评分[M(P₂₅, P₇₅)，分]
对照组	30	68.00(64.50, 73.00)	20(66.7)	10(33.3)	3.41±1.20	4.00(4.00, 5.00)
观察组	30	67.50(63.75, 72.25)	19(63.3)	11(36.7)	3.32±0.93	4.00(4.00, 5.00)
统计量		-0.385^a	0.073^b		0.325^c	-0.532^a
P值		0.700	0.787		0.746	0.595
注：^a为Z值，^b为χ²值，^c为t值。

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表 2 2组急性缺血性脑卒中机械取栓治疗患者救治时间比较[M(P₂₅, P₇₅), min]

Table 2. Comparison of treatment time between two groups of patients with acute ischemic stroke treated with mechanical thrombectomy [M(P₂₅, P₇₅), min]

组别	例数	DNT	DPT	DRT
对照组	30	45.50(41.00, 51.25)	90.50(85.00, 98.50)	122.50(111.50, 128.25)
观察组	30	43.00(30.75, 49.00)	88.00(82.50, 88.25)	115.50(109.50, 118.00)
Z值		-2.235	-2.966	-2.738
P值		0.025	0.003	0.006

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表 3 2组急性缺血性脑卒中机械取栓治疗患者血管再通率比较

Table 3. Comparison of vascular revascularization rate in patients with acute ischemic stroke treated with mechanical thrombectomy between 2 groups

组别	例数	0级[例(%)]	1级[例(%)]	2a级[例(%)]	2b级[例(%)]	3级[例(%)]	再通率(%)
对照组	30	2(6.7)	2(6.7)	6(20.0)	7(23.3)	13(43.3)	66.7(20/30)
观察组	30	1(3.3)	1(3.3)	1(3.3)	6(20.0)	21(70.0)	90.0(27/30)
注：2组患者血管再通率比较，χ²=4.812，P=0.028。

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表 4 2组急性缺血性脑卒中机械取栓治疗患者并发症发生率比较

Table 4. Comparison of complication rate of patients with acute ischemic stroke treated with mechanical thrombectomy between 2 groups

组别	例数	脑出血[例(%)]	穿刺点出血[例(%)]	肺部感染[例(%)]	泌尿系统感染[例(%)]	深静脉血栓形成[例(%)]	并发症发生率(%)
对照组	30	3(10.0)	1(3.3)	9(30.0)	2(6.7)	2(6.7)	56.7(17/30)
观察组	30	2(6.7)	0	6(20.0)	0	1(3.3)	30.0(9/30)
注：2组患者并发症发生率比较，χ²=4.344，P=0.037。

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表 5 2组急性缺血性脑卒中机械取栓治疗患者护理满意度比较

Table 5. Comparison of nursing satisfaction between two groups of patients with acute ischemic stroke treated with mechanical thrombectomy

组别	例数	非常满意[例(%)]	满意[例(%)]	一般满意[例(%)]	不满意[例(%)]	满意率(%)
对照组	30	16(53.3)	4(13.3)	2(6.7)	8(26.7)	73.3(22/30)
观察组	30	23(76.7)	5(16.7)	1(3.3)	1(3.3)	96.7(29/30)
注：2组患者并发症发生率比较，χ²=4.706，P=0.030。

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