本文關(guān)鍵詞：我國(guó)實(shí)施姑息護(hù)理的系統(tǒng)評(píng)價(jià)　出處：《重慶醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的:系統(tǒng)評(píng)價(jià)我國(guó)姑息護(hù)理的干預(yù)效果,總結(jié)我國(guó)姑息護(hù)理的現(xiàn)狀,分析我國(guó)姑息護(hù)理在組織、實(shí)施、評(píng)價(jià)等方面的不足,提出可行性的建議,為臨床姑息護(hù)理實(shí)施提供循證證據(jù)。方法:計(jì)算機(jī)檢索PubMed、Embase、Medline、Web of Science(SCI)、Science Direct(Elsevier Science)、中國(guó)期刊網(wǎng)全文數(shù)據(jù)庫(kù)(中國(guó)知網(wǎng)CNKI)、維普中文科技期刊數(shù)據(jù)庫(kù)(VIP)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、萬方醫(yī)學(xué)網(wǎng)數(shù)據(jù)庫(kù)上從2000年1月至2016年1月公開發(fā)表的關(guān)于我國(guó)姑息護(hù)理的隨機(jī)對(duì)照試驗(yàn)研究。參考Cochrane指導(dǎo)手冊(cè)的評(píng)價(jià)標(biāo)準(zhǔn),對(duì)符合納入標(biāo)準(zhǔn)的文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià)。對(duì)姑息護(hù)理的護(hù)理對(duì)象、實(shí)施者、護(hù)理內(nèi)容、評(píng)價(jià)指標(biāo)及工具等進(jìn)行定性系統(tǒng)評(píng)價(jià),并用ReMan5.3軟件對(duì)姑息護(hù)理的干預(yù)效果從生存質(zhì)量、心理狀況、患者滿意度等方面進(jìn)行Meta分析。結(jié)果:1.通過系統(tǒng)全面的文獻(xiàn)檢索,一共納入40篇隨機(jī)對(duì)照試驗(yàn)研究。文獻(xiàn)方法學(xué)質(zhì)量評(píng)價(jià)全部為B級(jí)。2.納入研究的姑息護(hù)理對(duì)象共3407人,包括癌癥患者(90.3%)、非惡性疾病患者(7.3%)及患者家屬(2.3%);且94.3%的研究對(duì)象來自住院患者,其余來自于社區(qū)。姑息護(hù)理的實(shí)施者包括護(hù)士(92.3%)、醫(yī)生(53.8%)、患者家屬(15.4%)、心理治療師(12.8%)、康復(fù)治療師(5.12%)、社會(huì)工作者(5.12%)及志愿者(5.12%);僅5%的實(shí)施者接受了專業(yè)化培訓(xùn),22.5%實(shí)施者是由多種學(xué)科的人員組成的姑息護(hù)理團(tuán)隊(duì)。姑息護(hù)理的內(nèi)容比較全面,主要的護(hù)理措施是:控制癥狀(85%)、心理護(hù)理(80%)、支持家屬(47.5%)、基礎(chǔ)護(hù)理(45%)及死亡教育(42.5%)。評(píng)價(jià)指標(biāo)豐富多樣,包括生存質(zhì)量、心理狀況、癥狀控制、患者滿意度及其他五大方面。3.癌癥患者姑息護(hù)理干預(yù)的效果(1)生活質(zhì)量:姑息護(hù)理干預(yù)后2周、3周、4周、8周及12周時(shí),其合并效應(yīng)量分別為[smd=0.67,95%ci(-0.38,1.72),p=0.21][smd=1.42,95%ci(0.31,2.54),p=0.01][smd=4.50,95%ci(2.17,6.82),p0.00001][smd=1.91,95%ci(0.13,3.70),p=0.04][smd=4.74,95%ci(2.67,6.80),p0.00001](2)心理狀況:姑息護(hù)理干預(yù)后2周、4周、8周及12周時(shí),對(duì)患者焦慮情緒影響的合并效應(yīng)量分別為[smd=-0.53,95%ci(-1.10,0.05),p=0.07][smd=-0.90,95%ci(-1.28,-0.52),p0.00001][smd=-1.01,95%ci(-1.22,-0.79),p0.00001][smd=-1.78,95%ci(-2.00,-1.55),p0.00001];姑息護(hù)理干預(yù)后2周、12周時(shí),對(duì)患者抑郁情緒影響的合并效應(yīng)量分別為[smd=-1.00,95%ci(-2.08,0.09),p=0.07][smd=-1.55,95%ci(-2.72,-0.38),p0.0001](3)癥狀:描述性分析結(jié)果顯示姑息護(hù)理組疲乏、疼痛程度較對(duì)照組減輕(p0.01或p0.05)。(4)患者滿意度:描述性分析結(jié)果顯示姑息護(hù)理組患者滿意度高于對(duì)照組(P0.01或P0.05)。4.非惡性疾病患者姑息護(hù)理的干預(yù)效果:描述性分析結(jié)果顯示姑息護(hù)理組生存質(zhì)量、心理狀況、癥狀控制、滿意度均優(yōu)于對(duì)照組(P0.01或P0.05)。結(jié)論:1.姑息護(hù)理研究在國(guó)內(nèi)得到廣泛關(guān)注,但相關(guān)研究的方法學(xué)質(zhì)量不高,均為中等。2.我國(guó)姑息護(hù)理研究的對(duì)象仍以癌癥患者為主,對(duì)非惡性疾病患者及患者家屬的關(guān)注較少;研究的樣本量相對(duì)全國(guó)現(xiàn)有患病人數(shù)較小,代表性較弱;姑息護(hù)理的內(nèi)容及評(píng)價(jià)指標(biāo)較全面,但相對(duì)缺乏專業(yè)的姑息護(hù)理團(tuán)隊(duì)。3.姑息護(hù)理短期內(nèi)能夠提高癌癥患者的生存質(zhì)量,改善焦慮抑郁情緒,緩解疼痛、疲乏癥狀,提高患者滿意度。4.姑息護(hù)理對(duì)非惡性疾病患者的生存質(zhì)量、心理狀況、癥狀控制等方面均有一定的促進(jìn)作用,但還需要大樣本的嚴(yán)格設(shè)計(jì)的隨機(jī)對(duì)照試驗(yàn)加以佐證。5.姑息護(hù)理對(duì)患者家屬干預(yù)效果由于納入文獻(xiàn)的數(shù)量過少而不能得到肯定的結(jié)論。
[Abstract]:Objective: To evaluate the intervention effect of palliative care in our country, summarizes the status of palliative care in our country, our analysis of palliative care in the organization, implementation, evaluation and other aspects of the problem, put forward the feasible advice for clinical implementation of palliative care to provide evidence-based evidence. Methods: computer retrieval of PubMed, Embase, Medline, Web, of Science (SCI), Science Direct (Elsevier Science), Chinese Journal Full-text Database (Chinese HowNet CNKI), VIP Chinese scientific journal database (VIP), Chinese biomedical literature database (CBM), a randomized controlled trial of palliative care in our country the Wanfang database from January 2000 to January 2016 published. Refer to the Cochrane manual evaluation standards, to meet the inclusion criteria to evaluate the quality of nursing documents. The object of palliative care practitioners, nursing content, evaluation index and tools for The system of evaluation, and the intervention effect of palliative care with the ReMan5.3 software from the quality of life, mental status, patient satisfaction and other aspects of Meta analysis. Results: 1. through systematic literature search, a total of 40 RCTs. Research method of literature quality evaluation for all B.2. included in the study of palliative care the object of a total of 3407 people, including cancer patients (90.3%), patients with non malignant diseases (7.3%) and the families of patients (2.3%); the research object and 94.3% from patients, the rest from the community. The implementation of nursing including palliative nurse (92.3%), doctors (53.8%), family members of patients (15.4%), a psychotherapist (12.8%) (5.12%), rehabilitation therapists, social workers and volunteers (5.12%) (5.12%); the implementation of only 5% received professional training, the implementation of 22.5% is composed of a variety of subjects' palliative care team. Palliative care content than Comprehensive nursing measures are the main symptom control (85%), psychological nursing (80%), family support (47.5%), basic nursing (45%) and death education (42.5%). The evaluation index is abundant, including quality of life, mental status, symptom control, patient satisfaction and other aspects of the five cancer patients with.3. the effect of palliative nursing intervention on quality of life (1): 2 weeks after palliative nursing intervention for 3 weeks, 4 weeks, 8 weeks and 12 weeks, the combined effect of the amount of [smd=0.67,95%ci (-0.38,1.72), p=0.21][smd=1.42,95%ci (0.31,2.54), p=0.01][smd=4.50,95%ci (2.17,6.82), p0.00001][smd=1.91,95%ci (0.13,3.70), p=0.04][smd=4.74,95%ci (2.67,6.80), p0.00001] (2): after 2 weeks, the psychological status of palliative nursing intervention for 4 weeks, 8 weeks and 12 weeks, the amount of combined effects on the anxiety of patients affected by smd=-0.53,95%ci respectively (-1.10,0.05), p=0.07][smd=-0.90,95%ci (-1.28, -0.52), p0.00001][smd=-1. 01,95%ci (-1.22, -0.79), p0.00001][smd=-1.78,95%ci (-2.00, -1.55), p0.00001]; 2 weeks of palliative care after 12 weeks, the amount of combined effects on depression effect were [smd=-1.00,95%ci (-2.08,0.09), p=0.07][smd=-1.55,95%ci (-2.72, -0.38), p0.0001] (3): descriptive analysis results showed that the symptoms of fatigue of palliative care group the degree of pain relief, compared with the control group (P0.01 or P0.05). (4) patient satisfaction: descriptive analysis showed that palliative nursing satisfaction of patients was higher than the control group (P0.01 or P0.05).4. non intervention effect of palliative care in patients with malignant diseases: a descriptive analysis showed that palliative care group quality of life, mental status, symptom control, satisfaction were better than the control group (P0.01 or P0.05). Conclusion: 1. palliative care research is widely concerned in China, but the related research method of quality is not high, are medium.2. of palliative care in our country The object of study is still dominated by cancer patients, less in patients with non malignant diseases and patient concerns; the study sample size relative to the existing national prevalence of small, representative is weak; the content and the evaluation of palliative care is comprehensive, but the relative lack of professional palliative nursing team.3. palliative care can improve the quality of life in the short term for cancer patients, improve anxiety and depression, relieve pain, fatigue symptoms, improve patient satisfaction.4. palliative care on the quality of survival of patients with non malignant diseases, mental health and role has a set of symptom control, but also need to rigorously designed RCTs with large sample to support the effect of palliative intervention on patients with.5. family nursing care of the number of documents is too small and can not get a positive conclusion.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R47

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

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本文編號(hào)：1366904