大脑中动脉不同闭塞部位所致脑梗死静脉溶栓患者的护理

摘要

目的 比较不同大脑中动脉闭塞(MCAO)部位脑梗死患者接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的疗效.方法 收集发病4.5h内接受rt-PA静脉溶栓治疗的急性MCAO所致脑梗死患者52例,并将MCA分为起始部闭塞(Ⅰ型)、主干远端闭塞(Ⅱ型)及分支闭塞(Ⅲ型),溶栓后24h美国国立卫生研究院卒中量表(NIHSS)评分下降≥4分或降至0分为早期症状改善.比较3组间的基线资料、溶栓前后NIHSS评分、出血转化发生率及7d死亡率,回顾性分析静脉溶栓过程中,不同闭塞部位患者的护理要点.结果 52例中Ⅰ型15例(28.8％),Ⅱ型12例(23.1％),Ⅲ型25例(48.1％).3组患者间心房颤动史、入院NIHSS评分及24 h NIHSS评分比较差异有统计学意义.从疗效和安全性上看,早期症状改善Ⅰ型4例(26.7％),Ⅱ型9例(75.0％),Ⅲ型19例(76.0％),Ⅰ型疗效最差且症状性颅内出血、7d病死率最高.结论 不同MCAO部位所致脑梗死患者静脉溶栓的疗效及安全性不同,护士应密切监测Ⅰ型患者的血压、意识、瞳孔、肌力及皮肤黏膜特征等变化,做到早发现,早汇报,早处理.%Objective To study the effect of intravenous rt-PA thrombolysis in cerebral infarction patients with the middle cerebral artery (MCAO) occlusion of different sites.Methods A total of 52 patients with acute MCAO treated by intravenous rt-PA thrombolysis within 4.5 hours were collected.The sites of MCA occlusion were classified into the origin of the MCA (type Ⅰ),the MCA trunk distal to the lenticulostriate arteries (type Ⅱ) and the branches of the MCA (type Ⅲ).Early symptom improvement was defined as 24 h NIHSS score decreased ≥ 4 points or down to 0 point after intravenous thrombolysis.Clinical data were obtained and compared among patients with the middle cerebral artery (MCA) occlusion of different sites.The key points in nursing were analyzed.Results Among 52 enrolled patients,15 (28.8％) were classified as type Ⅰ and 12(23.1％) as type Ⅱ and 25 (78.1％) as type Ⅲ.Atrial fibrillation,baseline National Institutes of Health Stroke Scale (NIHSS) score and 24 h NIHSS score showed significant differences among three groups.In early symptom improvement cases,type Ⅰ occurred in 4 cases,type Ⅱ in 9 cases and type Ⅲ in 19 cases,and the efficacy of cases with type Ⅰ was poorest,and had highest 7 d mortality rate and intracerebral hemorrhage.Conclusion Different sites of MCA occlusion may indicate different effect in patients with intravenous thrombolysis.The nurse should pay close attention to patients'blood pressure,consciousness,pupil,muscle and skin mucous membrane characteristics and so on.Meanwhile,they can do early detection,early reporting and early treatment and effort to improve patients' prognosis.