2021年2月护理学报February,202146第28卷第3期Joumal of Nursing(China)Vol.28 No.3【循证护理】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王亚玲，王冰寒，张艳，尹雪，蒋辛，熊晓明，黎华丽(华中科技大学同济医学院附属协和医院神经内科，湖北武汉430000)[摘要]目的选取回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、BMI、PubMed、Up To Date,NGC、GNSIGN、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/关国卒中学会网站、欧洲卒中组织网站、加拿大卒中网站，从中透选出符合纳入标准的文献。由2名研究员对文就质量进行独立评价、证据提取和证据踪合。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。结论委以基于循证的标准化预防策酪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回情、临床实际和患者意恩，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。[关键词]急性缺血性脑卒中：溶栓；出血转化：症状性脑出血：循证护理[中图分类号1R473.74[文献标识码]AD01]10.16460.issm1008-9969,2021.03.046Best Evidence Summary for Prevention of Hemorrhagic Transformation after Thrombolysis inPatients with Acute Ischemic StrokeWANG Ya-ling.WANG Bing-han,ZHANG Yan.YIN Xue,JIANG Xin,XIONG Xiao-ming.LI Hua-li(Dept.of Neurology,Union Hospital.Tongi Medical College,Huahong University of Science and Technology.Wuhan 430000.China)Abstract:Objective To summarize the best evidence for the prevention of hemorrhagic transformation after thrombolysis in patientswith acute ischemic stroke and to provide reference for nursing staff to reduce the incidence of hemorrhagic transformation afterthrombolysis 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 weresummarized from seven aspects:risk factors,condition monitoring,blood pressure management,symptom identification,symptomatictreatment,medication management and diet management.Conclusion Evidence-based standardized prevention strategy should beadopted for the prevention of hemorrhagic transformation after thrombolysis of acute ischemic stroke.It is necessary to select evidenceaccording to the national conditions,clinical practice and patients'wishes.When applying evidence,the best evidence should beapplied to the prevention and management of haemorrhage transformation after thrombolysis of acute ischemic stroke,so as to reducethe incidence of hemorrhagic transformation,promote the continuous improvement of nursing quality,the clinical outcome of patientsand the satisfaction of patients.Key words:acute ischemic stroke;thrombolysis;hemorrhagic transformation;symptomatic intracerebral hemorrhage;evidence-based nursing急性缺血性脑卒中(acute ischemic stroke,荐。而应用溶栓药物会增加出血转化(hemorrhagicAIS)是最常见的卒中类型.占我国脑卒中的69.6%transformation,HT)的风险。急性脑梗死溶栓后出血-70.8%。其发病率高、致残率高、死亡率高、复发转化发生率为10%-48%，而静脉溶栓可增加症状性率高，并发症多即“四高一多”的特点[3]。静脉溶栓(Symptomatic intracerebral hemorrhage,SICH)(intravenous thrombolysis
