急性缺血性脑卒中静脉溶栓护理指南

目的 制订《急性缺血性脑卒中静脉溶栓护理指南》，作为实施急性缺血性脑卒中静脉溶栓护理的指导工具，以规范溶栓治疗的护理行为。方法 严格按照循证护理实践指南制订的方法，构建《急性缺血性脑卒中静脉溶栓护理指南》草案，采用临床指南研究与评估系统目录Ⅱ对指南草案进行专家评审，根据专家评审结果和建议对指南进行修改，形成正式指南。结果 构建的指南推荐意见涵盖了院内组织管理、病情观察、并发症的观察与处理、体位与离床活动和质量管理共5个方面的内容。结论 《急性缺血性脑卒中静脉溶栓护理指南》是根据最佳证据、临床实际情况以及专业人员的判断形成的循证指南，可作为参与急性缺血性脑卒中患者静脉溶栓治疗的临床护理人员进行科学决策的实践依据。

Nursing guidelines for intravenous thrombolysis in acute ischemic stroke

Objective To develop an intravenous thrombolysis nursing guideline for acute ischemic stroke as a guiding tool for the implementation of intravenous thrombolysis for acute ischemic stroke，and to provide a reference for the practice and management of nursing in the standardization of thrombolytic therapy. Methods According to the method of evidence-based nursing practice guidelines，the draft of intravenous thrombolysis nursing guidelines for acute ischemic stroke was constructed. The draft guidelines were reviewed by experts using the catalogue of Clinical Guidelines Research and Evaluation System Ⅱ. According to the results and suggestions of expert review，the guidelines were modified to form the formal guidelines. Results The recommendations included 5 aspects，namely hospital organization management，disease observation，observation and treatment of complications，posture and bed-leaving activities，and quality management. Conclusion The guidelines for intravenous thrombolysis nursing in acute ischemic stroke are evidence-based guidelines based on the best evidence，clinical practice and the judgment of professionals，and can be used as a practical basis for clinical medical staff to make scientific decisions on intravenous thrombolysis therapy in patients with acute ischemic stroke.