Abstract:

Objective To develop the Nursing Guidelines for Patients with Severe Ischemic Stroke，aiming to provide a scientific basis for clinical nursing practice during the acute phase for patients with severe ischemic stroke，and to promote the standardization of nursing. Methods Strictly adhering to the development process for evidence-based nursing practice guidelines，a draft of the Nursing Guidelines for Patients with Severe Ischemic Stroke was constructed. The appraisal of guidelines for research & evaluation Ⅱ was used to conduct a comprehensive expert appraisal of the draft. The guidelines were subsequently revised based on the expert appraisal results and suggestions，culminating in the formation of the final formal guidelines. Results The recommendations of the guidelines cover 4 key areas：multidimensional monitoring care，multisystem functional support care，complication prevention and treatment care，and early rehabilitation care for severe ischemic stroke. Conclusion The Nursing Guidelines for Patients with Severe Ischemic Stroke is an evidence-based guideline formulated based on the best available evidence，clinical practical circumstances，and professional judgment. It can serve as a practical basis for scientific decision-making by clinical nursing staff involved in the acute-phase care of such patients.

Key words: Severe Ischemic Stroke, Guideline, Critical Care

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。

关键词: 重症缺血性脑卒中, 指南, 重症护理