中华护理杂志 ›› 2026, Vol. 61 ›› Issue (13): 1776-1783.DOI: 10.3761/j.issn.0254-1769.2026.13.007
中华护理学会内科护理专业委员会(执笔:曹闻亚1(
), 常红1,*(
), 金静芬2, 龚立超1, 王萱3, 曹咏新)3
收稿日期:2026-02-09
出版日期:2026-07-10
发布日期:2026-07-01
*通讯作者:
常红,E-mail:changhong19791111@126.com作者简介:曹闻亚:女,硕士,副主任护师,护士长,E-mail:247212508@qq.com
基金资助:
Internal Medicine Nursing Committee of Chinese Nursing Association (Writing Committee:CAO Wenya1(
), CHANG Hong1,*(
), JIN Jingfen2, GONG Lichao1, WANG Xuan3, CAO Yongxin)3
Received:2026-02-09
Online:2026-07-10
Published:2026-07-01
* Corresponding author:
CHANG Hong,E-mail:changhong19791111@126.comFunding program:摘要:
目的 制订“重症缺血性脑卒中患者护理指南”,为重症缺血性脑卒中患者急性期的临床护理实践提供科学依据,以推动护理的规范化。方法 严格遵循循证护理实践指南的制订流程,构建“重症缺血性脑卒中患者护理指南”草案。采用临床指南研究与评估工具Ⅱ对其进行专家评审,并根据专家评审结果及建议对指南进行修订,最终形成正式指南。结果 “重症缺血性脑卒中患者护理指南”推荐意见涵盖了多维度监测护理、多系统功能支持护理、并发症防治护理及早期康复护理4个方面。结论 “重症缺血性脑卒中患者护理指南”是基于最佳证据、临床实际情况及专业人员判断形成的循证指南,可为从事此类患者急性期护理的护士提供科学决策的实践依据。
中华护理学会内科护理专业委员会(执笔:曹闻亚, 常红, 金静芬, 龚立超, 王萱, 曹咏新). 重症缺血性脑卒中患者护理指南[J]. 中华护理杂志, 2026, 61(13): 1776-1783.
Internal Medicine Nursing Committee of Chinese Nursing Association (Writing Committee:CAO Wenya, CHANG Hong, JIN Jingfen, GONG Lichao, WANG Xuan, CAO Yongxin). Nursing guidelines for patients with severe ischemic stroke[J]. Chinese Journal of Nursing, 2026, 61(13): 1776-1783.
| [1] |
Ma QF, Li R, Wang LJ, et al. Temporal trend and attributable risk factors of stroke burden in China,1990-2019:an analysis for the Global Burden of Disease Study 2019[J]. Lancet Public Health, 2021, 6(12):e897-e906.
DOI URL |
| [2] | 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国重症卒中管理指南2024[J]. 中华神经科杂志, 2024, 57(7):698-714. |
| Chinese Society of Neurology,Chinese Medical Association; Chinese Society of Cerebrovascular Disease, Chinese Medical Association. Chinese guidelines for the management of severe stroke 2024[J]. Chin J Neurol, 2024, 57(7):698-714. | |
| [3] | 国家卫生健康委员会. 脑血管病防治指南(2024年版)[J]. 磁共振成像, 2025, 16(1):1-8. |
| National Health Commission. Guideline for prevention and treatment of cerebrovascular disease(2024 edition)[J]. Chin J Magn Reson Imag, 2025, 16(1):1-8. | |
| [4] | 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性卒中诊治指南2023[J]. 中华神经科杂志, 2024, 57(6):523-559. |
| Chinese Society of Neurology,Chinese Medical Association; Chinese Society of Cerebrovascular Disease, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2023[J]. Chin J Neurol, 2024, 57(6):523-559. | |
| [5] | 中国卒中学会,《中国卒中学会急性缺血性卒中再灌注治疗指南》编写组,王拥军. 中国卒中学会急性缺血性卒中再灌注治疗指南2024[J]. 中国卒中杂志, 2024, 19(12):1460-1478. |
|
Chinese Stroke Association, Writing Group of the Chinese Stroke Association Guidelines for Reperfusion Therapy in Acute Ischemic Stroke. Chinese stroke association guidelines on reperfusion therapy for acute ischemic stroke 2024[J]. Chin J Stroke, 2024, 19(12):1460-1478.
DOI |
|
| [6] | Le Terrier C, Sigaut S, Abou Arab O. Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients[J]. Anaesth Crit Care Pain Med, 2023, 42(5):101293. |
| [7] | 中华医学会神经病学分会神经重症协作组,中国医师协会神经内科医师分会神经重症专业委员会. 难治性颅内压增高的监测与治疗中国专家共识[J]. 中华医学杂志, 2018, 98(45):3643-3652. |
| Neurological Intensive Care Collaboration Group of the Chinese Society of Neurology,Neurocritical Care Committee of the Neurologist Branch of the Chinese Medical Doctor Association. China expert consensus on monitoring and treatment of refractory intracranial hypertension[J]. Natl Med J China, 2018, 98(45):3643-3652. | |
| [8] | Oliveira-Filho J. Intravenous thrombolytic therapy for acute ischemic stroke:therapeutic use[EB/OL]. (2026-03-05)[2026-03-25]. https://www.uptodate.com/contents/zh-Hans/intravenous-thrombolytic-therapy-for-acute-ischemic-stroke-therapeutic-use?search=Intravenous%20thrombolytic%20therapy%20for%20acute%20ischemic%20stroke%3A%20Therapeutic%20use&source=search_result&selectedTitle=1-150&usage_type=default&display_rank=1. |
| [9] |
Cook AM, Morgan Jones G, Hawryluk GWJ, et al. Guidelines for the acute treatment of cerebral edema in neurocritical care patients[J]. Neurocritical Care, 2020, 32(3):647-666.
DOI PMID |
| [10] | Heran M, Lindsay P, Gubitz G, et al. Canadian stroke best practice recommendations:acute stroke management,7th edition practice guidelines update,2022[J]. Can J Neurol Sci, 2024, 51(1):1-31. |
| [11] |
中华护理学会内科专业委员会,首都医科大学宣武医院. 急性缺血性脑卒中静脉溶栓护理指南[J]. 中华护理杂志, 2023, 58(1):10-15.
DOI |
|
Internal Medicine Committee of Chinese Nursing Association,Xuanwu Hospital,Capital Medical University. Nursing guidelines for intravenous thrombolysis in acute ischemic stroke[J]. Chin J Nurs, 2023, 58(1):10-15.
DOI |
|
| [12] |
Nathanson MH, Andrzejowski J, Dinsmore J, et al. Guidelines for safe transfer of the brain-injured patient:trauma and stroke,2019:guidelines from the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society[J]. Anaesthesia, 2020, 75(2):234-246.
DOI PMID |
| [13] | 潘钰, 谢欲晓, 张皓, 等. 脑卒中重症康复指南[J]. 康复学报, 2025, 35(5):453-462. |
| Pan Y, Xie YX, Zhang H, et al. Guidelines for stroke critical care rehabilitation[J]. Rehabil Med, 2025, 35(5):453-462. | |
| [14] | Sandset EC, Anderson CS, Bath PM, et al. European Stroke Organisation(ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage[J]. Eur Stroke J, 2021, 6(2):XLVIII-LXXXIX. |
| [15] | 中华医学会神经外科学分会,中国神经外科重症管理协作组. 中国神经外科重症管理专家共识(2020版)[J]. 中华医学杂志, 2020, 100(19):1443-1458. |
| Chinese Society of Neurosurgery,Chinese Medical Association; Chinese Neurosurgery Intensive Care Management Collaborative Group. Expert consensus on critical care management of neurosurgery in China(2020 edition)[J]. Natl Med J China, 2020, 100(19):1443-1458. | |
| [16] | 中华医学会心血管病学分会高血压学组,中华心血管病杂志编辑委员会. 成人四肢血压测量的中国专家共识[J]. 中华心血管病杂志, 2021, 49(10):963-971. |
| Hypertension Group of the Chinese Society of Cardiology,Chinese Medical Association; Editorial Board of Chinese Journal of Cardiology. Chinese expert consensus on the four-limb blood pressure measurement in adults[J]. Chin J Cardiol, 2021, 49(10):963-971. | |
| [17] |
中华护理学会重症护理专业委员会. 成人重症患者颅内压增高防控护理专家共识[J]. 中华护理杂志, 2024, 59(21):2606-2610.
DOI |
|
Critical Care Nursing Committee of Chinese Nursing Association. Expert consensus on the prevention and control of intracranial hypertension in adult critical illness[J]. Chin J Nurs, 2024, 59(21):2606-2610.
DOI |
|
| [18] | 中华医学会神经外科学分会, 中国神经外科重症管理协作组. 中国神经外科重症患者气道管理专家共识(2016)[J]. 中华医学杂志, 2016, 96(21):1639-1642. |
| Chinese Society of Neurosurgery,Chinese Medical Association; Chinese Neurosurgery Intensive Care Management Collaborative Group. Chinese expert consensus on airway management for neurosurgical critically ill patients(2016)[J]. Natl Med J China, 2016, 96(21):1639-1642. | |
| [19] | 中国医师协会神经外科分会神经重症专家委员会, 北京医学会神经外科分会神经外科危重症学组,中国神经外科重症管理协作组. 神经重症目标温度管理中国专家共识(2022版)[J]. 中华神经医学杂志, 2022, 21(7):649-656. |
| Neurosurgery Critical Care Expert Committee of the Chinese Medical Doctor Association,Neurosurgery Critical Care Group of the Beijing Medical Association,Chinese Neurosurgery Intensive Care Management Collaborative Group. Chinese expert consensus on targeted temperature management in neurocritical care(2022 edition)[J]. Chin J Neuromed, 2022, 21(7):649-656. | |
| [20] |
Wu ZX, Liu J, Zhang D, et al. Expert consensus on the glycemic management of critically ill patients[J]. J Intensive Med, 2022, 2(3):131-145.
DOI PMID |
| [21] | 中国卒中营养标准化管理专家委员会. 中国卒中营养标准化管理专家共识[J]. 中国卒中杂志, 2020, 15(6):681-689. |
| Chinese Stroke Nutrition Standardization Management Expert Committee. Chinese consensus on standardized nutrition management in patients with stroke[J]. Chin J Stroke, 2020, 15(6):681-689. | |
| [22] | 中华医学会神经外科学分会, 中国神经外科重症管理协作组. 中国神经外科重症患者感染诊治专家共识(2017)[J]. 中华医学杂志, 2017, 97(21):1607-1614. |
| Chinese Society of Neurosurgery,Chinese Medical Association; Chinese Neurosurgery Intensive Care Management Collaborative Group. Expert consensus on diagnosis and treatment of infection in severe patients of neurosurgery in China(2017)[J]. Natl Med J China, 2017, 97(21):1607-1614. | |
| [23] |
中华护理学会重症护理专业委员会, 北京医学会肠外肠内营养学分会护理学组. 神经重症患者肠内喂养护理专家共识[J]. 中华护理杂志, 2022, 57(3):261-264.
DOI |
|
Critical Care Nursing Committee of Chinese Nursing Association,Nursing Group of Parenteral and Enteral Nutrition Branch of Beijing Medical Association. Expert consensus on enteral feeding nursing for neurocritical patients[J]. Chin J Nurs, 2022, 57(3):261-264.
DOI |
|
| [24] | 国家神经系统疾病医疗质量控制中心神经重症亚专业工作组, 中国病理生理学会危重病医学专业委员会,《神经重症患者镇痛镇静治疗中国专家共识》工作组. 神经重症患者镇痛镇静治疗中国专家共识(2023)[J]. 中华危重病急救医学, 2023, 35(9):897-918. |
| National Center for Healthcare Quality Management in Neurological Diseases, Neurocritical Care Subspecialty Group;Critical Care Medicine Committee of Chinese Association of Patho-physiology;Working Group of Chinese Expert Consensus on Analgesia and Sedation for Neurocritical Patients. Chinese expert consensus on analgesia and sedation for neurocritical patients(2023)[J]. Chin Crit Care Med, 2023, 35(9):897-918. | |
| [25] | 张涛, 于嘉, 方伟, 等. 中国神经介入穿刺建立专家共识[J]. 中国脑血管病杂志, 2023, 20(9):637-648,F0003. |
| Zhang T, Yu J, Fang W, et al. Expert consensus on the establishment of neurointerventional puncture in China[J]. Chin J Cerebrovasc Dis, 2023, 20(9):637-648,F0003. | |
| [26] | 中国老年医学学会重症医学分会,浙江省重症医学临床医学研究中心. 老年重症患者静脉血栓栓塞症预防中国专家共识(2023)[J]. 中华老年病研究电子杂志, 2023, 10(2):1-13. |
| Branch of Critical Care Medicine,Chinese Geriatrics Society; Zhejiang Provincial Clinical Research Center for Critical Care Medicine. Expert consensus on the prevention of venous thromboembolism for elderly patients with critical illness in China(2023)[J]. Chin J Geriatr Res Electron Ed, 2023, 10(2):1-13. | |
| [27] | 中华护理学会内科专业委员会. T-CNAS 12-2020成人经口气管插管机械通气患者口腔护理[S]. 北京: 中华护理学会, 2021. |
| Internal Medicine Committee of Chinese Nursing Association. T-CNAS 12-2020 Oral care for adult patients undergoing orotracheal intubation with mechanical ventilation[S]. Beijing: Chinese Nursing Association, 2021. | |
| [28] | 国家卫生健康委员会. 中国脑卒中防治指导规范(2021年版)[EB/OL]. (2021-08-31)[2025-05-31]. https://www.nhc.gov.cn/cms-search/downFiles/674273fa2ec049cc97ff89102c472155.pdf. |
| National Health Commission. Guidelines for the prevention and treatment of stroke in China(2021 edition)[EB/OL].(2021-08-31)[2025-05-31]. https://www.nhc.gov.cn/cms-search/downFiles/674273fa2ec049cc97ff89102c472155.pdf. | |
| [29] |
Anestis DM, Tsitsopoulos PP, Tsonidis CA, et al. The current significance of the FOUR score:a systematic review and critical analysis of the literature[J]. J Neurol Sci, 2020, 409:116600.
DOI URL |
| [30] |
Cerecedo-Lopez CD, Cantu-Aldana A, Patel NJ, et al. Insulin in the management of acute ischemic stroke:a systematic review and meta-analysis[J]. World Neurosurg, 2020, 136:e514-e534.
DOI PMID |
| [31] | Boaden E, Burnell J, Hives L, et al. Screening for aspiration risk associated with dysphagia in acute stroke[J]. Cochrane Database Syst Rev, 2021, 10(10):CD012679. |
| [32] |
Jiang YL, Chi Y, Pan RJ, et al. Advancing stroke patient care:a network meta-analysis of dysphagia screening efficacy and personalization[J]. Front Neurol, 2024, 15:1380287.
DOI URL |
| [33] | 陈静然, 单凯, 陈光强, 等. 重症监护疼痛观察工具用于重症脑损伤患者疼痛评价的荟萃分析[J]. 中华重症医学电子杂志(网络版), 2019, 5(4):338-345. |
| Chen JR, Shan K, Chen GQ, et al. Pain assessment with Critical-care Pain Observation Tool(CPOT) in severe brain injury patients:a meta-analysis[J]. Chin J Crit Care Intensive Care Med Electron Ed, 2019, 5(4):338-345. | |
| [34] |
Rashid M, Kwok CS, Pancholy S, et al. Radial artery occlusion after transradial interventions:a systematic review and meta-analysis[J]. J Am Heart Assoc, 2016, 5:e002686.
DOI URL |
| [35] |
Mas-Serrano M, García-Pastor A, Iglesias-Mohedano AM, et al. Related factors with orolingual angioedema after intravenous alteplase in acute ischemic stroke:results from a single-center cohort and meta-analysis[J]. Neurol Sci, 2022, 43(1):441-452.
DOI |
| [36] | Fernando SM, Tran A, Cheng W, et al. Diagnosis of elevated intracranial pressure in critically ill adults:systematic review and meta-analysis[J]. BMJ,2019:l4225. |
| [37] | Ma ST, Fan XX, Zhao XP, et al. Risk factors for early-onset seizures after stroke:a systematic review and meta-analysis of 18 observational studies[J]. Brain Behav, 2021, 11(6): e02142. |
| [38] |
He QQ, Peng ZJ, He CY, et al. Effect of different mouthwashes on ventilator-related outcomes and mortality in intensive care unit patients:a network meta-analysis[J]. Aust Crit Care,2025, 38(1):101095.
DOI URL |
| [39] |
Ye Y, Zhou WQ, Cheng WK, et al. Short-term and long-term safety and efficacy of treatment of acute ischemic stroke with low-molecular-weight heparin:meta-analysis of 19 randomized controlled trials[J]. World Neurosurg, 2020, 141:e26-e41.
DOI URL |
| [40] |
Mariana de Aquino Miranda J, Mendes Borges V, Bazan R, et al. Early mobilization in acute stroke phase:a systematic review[J]. Top Stroke Rehabil, 2023, 30(2):157-168.
DOI URL |
| [41] |
祝晓娟, 虞杨, 王聪, 等. 急性缺血性脑卒中患者机械取栓术后血压管理的最佳证据总结[J]. 中华急危重症护理杂志, 2025, 6(3):365-371.
DOI |
| Zhu XJ, Yu Y, Wang C, et al. Summary of best evidence for management of blood pressure after mechanical embolectomy in patients with acute ischemic stroke[J]. Chin J Emerg Crit Care Nurs, 2025, 6(3):365-371. | |
| [42] |
王亚玲, 王冰寒, 张艳, 等. 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[J]. 护理学报, 2021, 28(3):46-52.
DOI |
| Wang YL, Wang BH, Zhang Y, et al. Best evidence summary for prevention of hemorrhagic transformation after thrombolysis in patients with acute ischemic stroke[J]. J Nurs(China), 2021, 28(3):46-52. | |
| [43] | 蔡久梅, 陈伟, 吴丽, 等. 脑卒中患者目标体温管理的最佳证据总结[J]. 中华现代护理杂志, 2023, 29(34):4650-4657. |
| Cai JM, Chen W, Wu L, et al. Summary of best evidence for target temperature management in stroke patients[J]. Chin J Mod Nurs, 2023, 29(34):4650-4657. | |
| [44] | 廖宗峰, 易巧利, 毛李烨, 等. 缺血性脑卒中患者高血糖管理的最佳证据总结[J]. 中华急危重症护理杂志, 2023, 4(2):172-178. |
| Liao ZF, Yi QL, Mao LY, et al. Summary of best evidence for hyperglycemia management in patients with ischemic stroke[J]. Chin J Emerg Crit Care Nurs, 2023, 4(2):172-178. |
| [1] | 梁江淑渊, 曾妃, 何鹏, 谢梦珊, 江悦, 蒋宗恒, 王建茗. 静脉-静脉体外膜肺氧合患者早期活动风险等级评估系统的构建及应用研究[J]. 中华护理杂志, 2026, 61(9): 1192-1199. |
| [2] | 王敏, 纪亚楠, 曹芳, 聂臣聪, 陈瑶, 张继权, 陈志美, 杜金磊. 危重症患者管饲依赖症状变化轨迹及影响因素研究[J]. 中华护理杂志, 2026, 61(6): 761-767. |
| [3] | 周飞飞, 乔文博, 任雅钰, 董真源, 郭力华, 詹慧伟, 姚丽萍, 严方, 高春华, 褚君卿. 1例肺动脉高压合并肺假性动脉瘤破裂患者过渡至肺移植的护理[J]. 中华护理杂志, 2026, 61(4): 557-560. |
| [4] | 徐楠, 乔筠, 陈芳, 周静, 江智霞. 基于眼动追踪技术的ICU经口气管插管患者沟通系统的构建及验证[J]. 中华护理杂志, 2026, 61(13): 1747-1753. |
| [5] | 童佩, 王芳, 袁嘉莹, 苏化, 曹勤利. 1例免疫介导的迟发性喉受累致急性气道梗阻患者的急救与护理[J]. 中华护理杂志, 2026, 61(11): 1540-1543. |
| [6] | 王艳, 潘文彦, 程立宏, 周子琳, 胡彦成, 张晓云. 1例行“废弃肝”移植联合肝脏分隔和门静脉结扎二步肝切除术患者的护理[J]. 中华护理杂志, 2025, 60(9): 1128-1131. |
| [7] | 徐美, 方晓眉. 8例重度免疫检查点抑制剂相关肺炎合并呼吸衰竭患者的护理[J]. 中华护理杂志, 2025, 60(7): 871-875. |
| [8] | 张煜, 金玉, 王淑芹, 万娜, 张春艳. 体外二氧化碳清除治疗3例慢性阻塞性肺疾病合并高碳酸血症患者的护理[J]. 中华护理杂志, 2025, 60(5): 539-544. |
| [9] | 中华护理学会老年护理专业委员会, 北京医院 国家老年医学中心, 中国医学科学院老年医学研究院, 北京大学护理学院(执笔:刘文静 王志稳 余跃琳 任欣 琚慧 陈宏 王君鑫 陈闪闪 周佳 伊默 王文霞 张玲娟 陈思烨 杨宇帆 王小萌 孙红). 老年人内在能力评估与维护指南[J]. 中华护理杂志, 2025, 60(3): 261-265. |
| [10] | 郭力华, 董真源, 高春华, 乔文博, 周飞飞, 邓琼琳, 褚君卿. 1例主动脉夹层动脉瘤破裂患者术后合并胸腔巨大血肿的护理[J]. 中华护理杂志, 2025, 60(24): 3032-3035. |
| [11] | 郭晓凡, 刘金龙, 俞伊莉, 徐云佳, 胡晓朦, 谢雨淅, 侯彬彬, 楼妍. 基于人工智能的临床决策支持系统在ICU中应用的范围综述[J]. 中华护理杂志, 2025, 60(23): 2933-2939. |
| [12] | 邓伟, 王英, 谭丽萍, 朱建军, 徐苏娟, 唐雯, 邹洁, 刘励军. ICU经口气管插管患者口咽分泌物微误吸风险预测模型的构建及初步验证[J]. 中华护理杂志, 2025, 60(21): 2620-2626. |
| [13] | 王亭舒, 姚丽, 刘焱, 荆蓓, 李钦钦, 王庭瑞. 重症患者ICU后综合征的发生现状及影响因素研究[J]. 中华护理杂志, 2025, 60(19): 2356-2363. |
| [14] | 中华护理学会重症护理专业委员会(执笔:熊杰 孙红 吴晓英 关欣 李黎明 张莉 田永明). 成人有创机械通气患者院内转运安全管理专家共识[J]. 中华护理杂志, 2025, 60(17): 2053-2055. |
| [15] | 王金宁, 潘向滢, 陈臣侃, 金佳家, 李佳. 2例心肺移植患者术前体外膜肺氧合辅助下实施步行康复训练的护理[J]. 中华护理杂志, 2025, 60(17): 2137-2140. |
| 阅读次数 | ||||||
|
全文 |
|
|||||
|
摘要 |
|
|||||