多模影像指导下个体化血管再通病人的护理

摘要

[目的]探讨在多模影像指导下急性缺血性卒中(AIS)病人接受重组组织型纤溶酶原激活剂(rtPA)静脉溶栓联合血管内治疗后护理工作的有效性及安全性,总结护理措施。[方法]筛选2014年1月—2014年12月就诊的17例行动静脉联合治疗的 AIS病人为研究对象,在溶栓前以及溶栓后1 h,2 h,24 h和出院时对其行美国国立卫生研究院神经功能缺损评分(NIHSS),评估神经功能缺损情况,出院时和溶栓后90 d行改良 Barthel 指数(MBI)评分评估日常生活能力和改良 Rankin量表(mRS)评估神经功能预后。[结果]17例病人中死亡1例,脑出血1例,蛛网膜下隙出血1例,其余14例病人出院时 NIHSS评分(7.36分±7.51分)比溶栓前(16.57分±6.07分)降低,差异有统计学意义(P=0.000)。溶栓后90 d日常生活能力 MBI比出院时有所提高,差异有统计学意义(50.07分±13.57分 vs 56.79分±13.12分,P=0.004)。病人90 d时神经功能预后较出院时 mRS评分有所改善,差异有统计学意义(1.71分±1.78分 vs 2.57分±1.56分,P=0.001)。[结论]在多模影像指导下,卒中病人个体化管理可以缩短其就诊到溶栓的时间(静脉溶栓)和就诊到穿刺的时间(血管内治疗),扩展时间窗能增加病人接受溶栓治疗的机会,有效提高病人血管再通率,促进神经功能恢复和日常生活能力提高。%Objective:To evaluate the effectiveness and safety of the nursing strategies of acute ischemic stroke (AIS)patients accepted rt PA intravenous thrombolysis and combined thrombolysis under the guidance of multi mode image.Methods:Total of 1 7 patients with AIS who underwent arterial and veno venous therapy from January 2014 to December 2014 were enrolled in the study.At the time before treatment,1 h,2 h,24 h after treatment and discharge,patients were assessed by the National Institutes of Health Stroke Scale(NIHSS)to e-valuate the neurological deficit.At discharge and 90 days after the treatment,patients were assessed by modified Barthel Index(MBI)to evaluate their ability of daily living,and modified Rankin Scale(mRS)to assess neural functional prognosis.Results:Among the 1 7 patients,1 died,1 developed cerebral hemorrhage,and 1 became sub-arachnoid hemorrhage;in the remaining 14 cases,the NIHSS score at discharged(7.36±7.51)was significantly reduced compare with pre thrombolysis(16.57±6.07),the difference was statistically significant(P=0.000).In daily life ability,MBI score at 90d post treatment(56.79±13.12)was higher than discharged(50.07±13.57), the difference was statistically significant(P=0.004).The mRS score at 90d post treatment(2.57±1.56)also higher than discharged(1.71 ±1.78),which achieved significant difference(P=0.001).Conclusion:Under the guidance of multimodal images,the individualized management of stroke patients could shorten the time of thrombolysis(intravenous thrombolysis)and the time of treatment (endovascular treatment).Extended time window could increase the patients’opportunities receiving thrombolysis treatment,effectively improve the re-canalization rate,and promote neurological function recovery and daily living ability.