卒中后神经康复中的早期护理干预：主要来自高资源环境的证据综合综述。

文献信息

中文摘要

背景： 卒中仍然是全球死亡和获得性长期残疾的主要原因，发病后的最初几天常常决定后续康复的安全性、强度、连续性和以人为中心的程度。早期康复由跨专业团队提供，其中护士通过持续监测、反复在床旁实施商定的计划、预防可避免的并发症以及跨班次和跨环境的协调做出独特贡献。本综合综述综合了与缺血性和出血性卒中后神经康复中早期护理贡献相关的当代证据。方法：通过结构化检索MEDLINE、CINAHL、Embase、Cochrane图书馆以及指定的指南和专业学会资源，识别指南、系统综述、随机试验和护理科学来源，然后使用透明的、基于标准的证据强度评估进行叙述性综合。结果：核心主题包括神经监测、吞咽安全、体位和肢体保护、基于准备度的活动、预防与不动相关的和医源性并发症、沟通和认知支持、情绪和疲劳护理、维护尊严的失禁康复、教育、二级预防和护理过渡。最强的证据支持有组织的卒中单元护理、及时的吞咽筛查、发热、血糖和吞咽的方案化管理、适当的机械静脉血栓栓塞预防以及针对选定患者的早期支持出院。对于极早期高剂量活动、常规夹板固定、若干口腔护理方案以及一些数字干预措施，证据则更为混杂。结论：大多数纳入证据来自高资源卒中系统，向低资源环境的可转移性需要情境适应。当早期护理干预的护理主导和共享组成部分在标准化但个体化的跨专业路径中明确界定，从而保持生理稳定性、尊严、公平可及性和长期参与时，其效果最佳。

英文摘要

Stroke remains a leading cause of death and acquired long-term disability worldwide, and the earliest days after onset frequently shape the safety, intensity, continuity, and person-centeredness of subsequent rehabilitation. Early rehabilitation is delivered by interprofessional teams, within which nurses make a distinctive contribution through continuous surveillance, repeated bedside implementation of agreed plans, prevention of avoidable complications, and coordination across shifts and settings. This comprehensive review synthesizes contemporary evidence relevant to early nursing contributions in post-stroke neurological rehabilitation for ischemic and hemorrhagic stroke. Guidelines, systematic reviews, randomized trials, and nursing-science sources were identified through structured searches of MEDLINE, CINAHL, Embase, the Cochrane Library, and named guideline and professional-society resources, then synthesized narratively using a transparent, criteria-based appraisal of evidence strength. Central themes include neurological surveillance, swallow safety, positioning and limb protection, readiness-based mobilization, prevention of immobility-related and iatrogenic complications, communication and cognitive support, mood and fatigue care, dignity-preserving continence rehabilitation, education, secondary prevention, and transitions of care. The strongest evidence supports organized stroke-unit care, timely swallow screening, protocolized management of fever, glycemia, and swallowing, appropriate mechanical venous thromboembolism prevention, and early supported discharge for selected patients. Evidence is more mixed for very early high-dose mobilization, routine splinting, several oral care protocols, and some digital interventions. Most included evidence was generated in high-resource stroke systems, and transferability to lower-resource settings requires contextual adaptation. Early nursing interventions are most effective when their nursing-led and shared components are clearly delineated within standardized yet individualized interprofessional pathways that preserve physiologic stability, dignity, equitable access, and long-term participation.