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

目的 检索、评价和整合急性缺血性脑卒中静脉溶栓院内全程管理的最佳证据,为制定急性缺血性脑卒中静脉溶栓院内全程管理方案提供依据。方法 计算机检索2011年1月—2021年12月发表于UpToDate、BMJ Best Practice、国际指南协作网 (Guidelines International Network, GIN)、苏格兰院际指南网（Scottish Intercollegiate Guidelines Network,SIGN）、英国国家卫生与临床优化研究所（National Institute for Health and Care Excellence, NICE）、美国国立指南库（National Guideline Clearinghouse, NGC）、Cochrane Library、JBI、Embase、PubMed、OVID、医脉通、中国知网、万方数据库的相关证据,类型包括临床决策、指南、证据总结、推荐实践、系统评价、专家共识 /立场声明。由2名研究者对符合纳入标准的文献进行质量评价、证据提取和证据综合。结果 共纳入13篇文献,包括指南5篇、系统评价3篇、证据总结1篇、专家共识/立场声明4篇,总结成急性缺血性脑卒中静脉溶栓预检分诊、病情评估、急性期护理、溶栓治疗、溶栓监护、并发症护理、质量管理7个维度43条证据。结论 急性缺血性脑卒中静脉溶栓院内全程管理的证据总结可为临床提供循证实践依据,在证据转化时,应结合医院环境、临床实际及患者意愿等选择性应用证据,改善患者结局。

Best Evidence Summary of Intra-hospital Management of Intravenous Thrombolysis in Acute Ischemic Stroke

Objective To search, evaluate and integrate the best evidence of intra-hospital management of intravenous thrombolysis in acute ischemic stroke, and to provide basis for intra-hospital management of intravenous thrombolysis in patients with acute ischemic stroke. Methods Computer search was conducted for all the evidence published on UpToDate, BMJ Best Practice, GIN, SIGN, NICE, NGC, Cochrane Library, JBI, Embase, PubMed, OVID, Yimai Tong, CNKI, Wanfang Database from January 2011 to December 2021, including guidelines, systematic evaluation, evidence summary, recommended practice and expert consensus. Two researchers conducted quality evaluation, evidence extraction and evidence synthesis for eligible articles. Results Thirteen articles were collected, including 5 guidelines, 3 systematic evaluations, 1 evidence summary, and 4 expert consensus/position statements. Forty-three pieces of evidence were summarized from 7 dimensions including preview triage, evaluating severity, acute care, thrombolysis treatment, thrombolysis guardianship, complications nursing, quality management in acute ischemic stroke. Conclusion The evidence summary of intra-hospital management of intravenous thrombolysis in acute ischemic stroke can provide evidence-based practice basis for clinical practice. In evidence transformation, selective application of evidence should be combined with hospital environment, clinical practice and patient willingness, so as to improve patient outcomes.