急性缺血性脑卒中患者溶栓术后预防出血转化的最佳证据总结

目的 选取国内外急性缺血性脑卒中溶栓术后患者预防出血转化的相关证据,并对最佳证据进行总结,为护理人员降低脑梗死溶栓术后出血转化提供参考。方法 使用计算机检索Cochrane Library、JBI、BMJ、PubMed、Up To Date、NGC、GIN、SIGN、NZGG、NICE、RNAO、中国知网、维普、万方数据库、中国生物医学数据库,并检索了美国心脏学会/美国卒中学会网站、欧洲卒中组织网站、加拿大卒中网站,从中遴选出符合纳入标准的文献。由2名研究员对文献质量进行独立评价、证据提取和证据综合。结果 共纳入17篇文献,其中指南9篇,系统评价5篇,专家共识/立场声明3篇。从 17 篇文献中共提取了 26 条证据,综合成 7 个维度分别是危险因素、病情监测、血压管理、症状识别、对症处理、药物管理、饮食管理。结论 要以基于循证的标准化预防策略解决急性脑梗死溶栓后出血转化的问题,应用证据时需结合我国国情、临床实际和患者意愿,有针对性地选择证据,促进最佳证据应用于急性缺血性脑卒中溶栓术后出血转化的预防和管理,从而降低脑梗死溶栓术后出血转化发生率,促进护理质量的持续改进,改善患者的临床结局,提升患者的满意度。

Best Evidence Summary for Prevention of Hemorrhagic Transformation after Thrombolysis in Patients with Acute Ischemic Stroke

Objective To summarize the best evidence for the prevention of hemorrhagic transformation after thrombolysis in patients with acute ischemic stroke and to provide reference for nursing staff to reduce the incidence of hemorrhagic transformation after thrombolysis of stroke. Methods We searched Cochrane Library, JBI, BMJ, PubMed, UpToDate, NGC, GIN, SIGN, NZGG, NICE, RNAO, CNKI, Vip Datebase, Wanfang Datebase, CBM and AHA/ASA, ESO and Canadian Stroke Best Practices for eligible literature. Two researchers independently appraised articles, and extracted data from eligible studies. Results Seventeen articles were enrolled, including 9 guidelines, 5 systematic reviews, 3 expert consensuses/position statement. Totally 26 items of best evidence were summarized from seven aspects：risk factors, condition monitoring, blood pressure management, symptom identification, symptomatic treatment, medication management and diet management. Conclusion Evidence-based standardized prevention strategy should be adopted for the prevention of hemorrhagic transformation after thrombolysis of acute ischemic stroke. It is necessary to select evidence according to the national conditions, clinical practice and patients' wishes. When applying evidence, the best evidence should be applied to the prevention and management of haemorrhage transformation after thrombolysis of acute ischemic stroke, so as to reduce the incidence of hemorrhagic transformation, promote the continuous improvement of nursing quality, the clinical outcome of patients and the satisfaction of patients.