Controversies in Acute Stroke Treatment

被引：14

作者：

Brethour, Mary K. ^{[1
]}

Nystrom, Karin V. ^{[2
,3
,4
]}

Broughton, Sandra ^{[4
]}

Kiernan, Terri E. ^{[5
]}

Perez, Amy ^{[6
]}

Handler, Diane ^{[7
]}

Swatzell, Victoria ^{[8
]}

Yang, Joanna Jiehong ^{[9
]}

Starr, Michele ^{[4
,10
]}

Seagraves, Karen B. ^{[6
]}

Cudlip, Fern ^{[11
]}

Biby, Sharon ^{[12
]}

Tocco, Susan ^{[13
]}

Owens, Pauline ^{[4
,14
]}

Alexandrov, Anne W. ^{[15
,16
]}

机构：

[1] Carle Hosp, Stroke Team, Urbana, IL 61801 USA

[2] Yale New Haven Med Ctr, New Haven, CT 06504 USA

[3] Stroke Ctr, New Haven, CT USA

[4] NET SMART Adv Practice Fellowship Program, Fountain Hills, AZ USA

[5] Mayo Clin, Neurol, Dept Neurol, Phoenix, AZ USA

[6] Marcus Stroke & Neurosci Ctr, Grady Hlth Syst, Atlanta, GA USA

[7] Mercy Med Ctr, Stroke Team, Cedar Rapids, IA USA

[8] Scottsdale Healthcare, Osborn Stroke Team, Scottsdale, AZ USA

[9] Loma Linda Univ, Med Ctr, Stroke Team, Loma Linda, CA USA

[10] James R Daniel Cerebrovasc & Stroke Ctr, Integris Baptist Med Ctr, Oklahoma City, OK USA

[11] Eden Med Ctr, Stroke Program, Castro Valley, CA USA

[12] Moses Cone Hosp, Stroke Ctr, Greensboro, NC USA

[13] Orlando Reg Med Ctr Inc, Stroke Team, Orlando, FL USA

[14] Middlemore Hosp, Counties Manukau Dist Hlth Board, Stroke Team, Auckland, New Zealand

[15] Univ Alabama Birmingham, NET SMART, Sch Nursing, Birmingham, AL 35294 USA

[16] Univ Alabama Birmingham, Comprehens Stroke Ctr, Birmingham, AL 35294 USA

来源：

AACN ADVANCED CRITICAL CARE | 2012年 / 23卷 / 02期

关键词：

acute stroke; advanced practice nurses; intra-arterial treatment; intravenous tissue plasminogen activator (tPA); head-of-bed positioning;

D O I：

10.1097/NCI.0b013e31824fe1b6

中图分类号：

R47 [护理学];

学科分类号：

1011 ;

摘要：

The evidence base supporting the management of patients with acute stroke is evolving at a rapid rate, as new methods that aim to reduce disability and death from stroke are explored. Intravenous tissue plasminogen activator remains the only treatment shown in numerous studies to reduce disability 3 months after stroke with no increase in the risk of death and a relatively minor rate of symptomatic intracerebral hemorrhage complications. Despite these findings, health care providers have been slow to adopt this evidence-based treatment, which results in many patients experiencing disability caused by stroke. Numerous controversies exist related to the management of patients with acute stroke, including the use of tissue plasminogen activator, positioning and early mobility, blood pressure lowering in acute intracerebral hemorrhage, and even the use of innovative advanced practice nurse-led stroke treatment teams, with varying amounts of evidence available to provide direction. This article explores controversies associated with both approved and evolving treatments for ischemic and hemorrhagic stroke and makes recommendations for practice on the basis of the body of existing evidence, with an aim to improve the delivery of acute stroke treatment.

引用

页码：158 / 172

页数：15

共 79 条

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