目的 构建适合于急诊预检分诊环境下使用的评估工具,帮助护士早期识别急性后循环缺血性脑卒中患者。方法 通过文献研究,运用德尔菲法对23名涵盖急诊护理管理、卒中中心领导、神经内科临床及护理领域的专家展开2轮函询。结果 2轮函询专家有效回收率为92%、100%,专家权威系数分别是0.959、0.970,肯德尔协调系数分别是0.230、0.341（P<0.001）。最终形成的急性后循环缺血性卒中分诊评估工具分为2个维度、8个评估项目、3类分诊护士指引、1个进入卒中中心标准。结论 急性后循环缺血性脑卒中预检分诊评估工具构建合理,研究方法科学,研究结果可靠,为急诊患者分诊流程优化、效率提高提供了有力依据。助推急诊护理专科能力进步。
Abstract
Objective To construct an assessment tool specifically designed for emergency settings to help identify acute posterior-circulation ischemic stroke (APCIS) patients during initial assessment. Methods Through literature review, the Delphi method was used to conduct two rounds of consultation with 23 experts in the field of emergency nursing management, stroke center, and neurology and nursing. Results The effective recovery rates of the two rounds of consultation were 92% and 100%, the expert authority coefficients 0.959 and 0.970, and the Kendall’s concordance coefficients 0.230 and 0.341, respectively (P<0.001). The final triage assessment tool for APCIS comprised two dimensions with eight assessment items, incorporated three triage nurse decision pathways, and established one stroke center admission criterion. Conclusion The constructed assessment tool for pre-examination and triage of APCIS is scientific and rigorous, and this reliable instrument provides an evidence-base foundation for optimizing emergency triage workflows and improving efficiency, while advancing specialized emergency nursing competencies.
关键词
后循环缺血 /
脑卒中 /
早期识别 /
预检分诊
Key words
posterior circulation ischemic /
stroke /
early identification /
pre-examination and triage
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参考文献
[1] Yao M, Ren Y, Jia Y, et al.Projected burden of stroke in China through 2050[J]. Chin Med J (Engl),2023,136(13):1598-1605. DOI:10.1097/CM9.0000000000002060.
[2] Virani SS, Alonso A, Benjamin EJ, et al.Heart disease and stroke statistics-2020 update: a report from the American Heart Association[J]. Circulation. 2020,141(9):e139-e596. DOI:10.1161/CIR.0000000000000757.
[3] 高萍,张标新,宋瑰琦,等.急性缺血性脑卒中静脉溶栓院内全程管理的最佳证据总结[J].护理学报,2022,29(14):37-42. DOI:10.16460/j.issn1008-9969.2022.14.037.
[4] 于龙娟,张婷婷,李晨,等.卒中护士预检分诊对卒中救治效率的影响[J].解放军护理杂志,2020,37(10):78-80. DOI:10.3969/j.issn.1008-9993.2020.10.020.
[5] 周丽萍,叶欢,娄洁香,等. 急性脑卒中筛查量表的研究进展[J]. 中华急危重症护理杂志,2023, 4(7):664-669. DOI:10.3761/j.issn.2096-7446.2023.07.019.
[6] Ahmed RA, Dmytriw AA, Regenhardt RW, et al.Posterior circulation cerebral infarction: a review of clinical, imaging features, management, and outcomes[J]. Eur J Radiol Open,2023(11):100523. DOI:10.1016/j.ejro.2023.100523.
[7] 刘雪云,胡小伟,蔡秀英,等.后循环缺血早期识别的研究进展[J].临床神经病学杂志,2018,31(2):151-154. DOI:10.3969/j.issn.1004-1648.2018.02.022.
[8] 王天中,李大欢,潘萌,等.急诊脑卒中识别量表诊断准确性的Meta分析[J].中华危重病急救医学,2019(5):607-613. DOI:10.3760/cma.j.issn.2095-4352.2019.05.017.
[9] 楼敏,丁晶,张玉生,等.中国脑血管病临床管理指南卒中组织化管理推荐意见[J].中国卒中杂志,2023,18(7):822-828. DOI:10.3969/j.issn.1673-5765.2023.07.013.
[10] 卢雪玲,杜翠色,陈丽婵,等.循证支持下针对脑卒中患者在急诊预检分诊及临床护理中的价值[J].实用临床护理学电子杂志,2020,5(26):118+127.
[11] 史冬雷,刘晓颖,周瑛.急诊预检分诊专家共识[J].中华急诊医学杂志,2018,27(6):599-604.
[12] 李双,李中岩.孤立性眩晕起病的后循环缺血性脑卒中患者临床分析[J].中国实用神经疾病杂志,2021,24(4):307-311. DOI:10.12083/SYSJ.2020.19.006.
[13] 曹学兵,张兆辉,彭小祥.急性后循环缺血性卒中早期识别与评估专家共识[J].卒中与神经疾病, 2021,28(2):245-252. DOI:10.3969/j.issn.1007-0478.2021.02.026.
[14] Chen R, Su R, Deng M,et al.posterior circulation ischemia risk score system to assist the diagnosis of dizziness[J]. J Stroke Cerebrovasc Dis, 2018,27(2):506-512. DOI:10.1016/j.jstrokecerebrovasdis.2017.09.027.
[15] 王敬凤. 无症状脑梗死患者的临床研究进展[J].中国城乡企业卫生,2022,37(9):65-67. DOI:10.16286/j.1003-5052.2022.09.024.
[16] Kim M, Park SY, Lee SE, et al.Significance of vertigo, imbalance, and other minor symptoms in hyperacute treatment of posterior circulation stroke[J]. Front Neurol, 2022(13):845707. DOI:10.3389/fneur.2022.845707.
[17] David AM, Jaleel A, Joy Mathew CM.Misdiagnosis of cerebellar infarcts and its outcome[J]. Cureus, 2023, 15(2):e35362. DOI:10.7759/cureus.35362.
[18] 刘平,姜树军.后循环缺血性卒中误诊分析[J].北京医学,2021,43(6):489-492. DOI:10.15932/j.0253-9713.2021.06.003.
[19] 黄欣莹,毛晨晖,后循环缺血性卒中.英国医学杂志中文版,2019,22(5):298-298. DOI:10.3760/cma.j.issn.1007-9742.2019.05.1187.
[20] Newman-Toker DE, Kerber KA, Hsieh YH, et al.HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness[J]. Acad Emerg Med, 2013,20(10):986-996. DOI:10.1111/acem.12223.
[21] Hsieh MJ, Chen YJ,Tang SC,et al.2020 Guideline for prehospital management, emergency evaluation and treatment ofpatients with acuteischemic stroke: a guideline for healthcare professionals from the Taiwan society of emergency medicine and Taiwan stroke society[J]. J Acute Med,2021, 11(1):12-17. DOI:10.6705/j.jacme.202103_11(1).0002.
[22] Ashcraft S, Wilson SE, Nyström KV,et al . American Heart Association council on cardiovascular and stroke nursing and the stroke council. care of the patient with acute ischemic stroke (prehospital and acute phase of care): update to the 2009 comprehensive nursing care scientific statement: a scientific statement from the American Heart Association[J]. Stroke, 2021,52(5):e164-e178. DOI:10.1161/STR.0000000000000356.
[23] Fekonja Z, Kmetec S, Fekonja U,et al.Factors contributing to patient safety during triage process in the emergency department: a systematic review[J]. J Clin Nurs,2023,32(17-18):5461-5477. DOI:10.1111/jocn.16622.
[24] 刘佳,陈志美,唐芳,等.基于Delphi和三维质量模型构建夜间中医护理门诊质量评价指标体系[J]. 护理学报,2024,31(19):42-46. DOI:10.16460/j.issn1008-9969.2024.19.042.
[25] 王熙,崔献梅.基于洋葱模型的综合三级甲等医院产科新入职护士独立上岗准入评价指标体系的构建[J].护理学报,2024,31(21):32-38.DOI:10.16460/j.issn1008-9969.2024.21.032.
[26] 李月仪,陈伟菊.德尔菲法在护理管理学中的应用现状[J].护理研究,2018,32(21):3339-3341.
[27] Mirhaghi A.Comments on "triage knowledge and practice and associated factors among emergency department nurses"[J].SAGE Open Nurs,2023(9):23779608231160475. DOI:10.1177/23779608231160475.
[28] 韩泉,张旭婷,楼敏. 卒中中心的组织化管理[J]. 中国卒中杂志,2015,10(6):488-493. DOI:10.3969/j.issn.1673-5765.2015.06.007.
[29] 王陇德,吉训明,康德智,等.《中国卒中中心报告2020》概要[J].中国脑血管病杂志,2021,18(11):737-743. DOI:10.3969/j.issn.1672-5921.2021.11.001.
基金
深圳市基础研究面上项目（20240809164314002号）
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