我国实施姑息护理的系统评价

发布时间：2018-01-02 00:26

本文关键词：我国实施姑息护理的系统评价　出处：《重庆医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:系统评价我国姑息护理的干预效果,总结我国姑息护理的现状,分析我国姑息护理在组织、实施、评价等方面的不足,提出可行性的建议,为临床姑息护理实施提供循证证据。方法:计算机检索PubMed、Embase、Medline、Web of Science(SCI)、Science Direct(Elsevier Science)、中国期刊网全文数据库(中国知网CNKI)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、万方医学网数据库上从2000年1月至2016年1月公开发表的关于我国姑息护理的随机对照试验研究。参考Cochrane指导手册的评价标准,对符合纳入标准的文献进行质量评价。对姑息护理的护理对象、实施者、护理内容、评价指标及工具等进行定性系统评价,并用ReMan5.3软件对姑息护理的干预效果从生存质量、心理状况、患者满意度等方面进行Meta分析。结果:1.通过系统全面的文献检索,一共纳入40篇随机对照试验研究。文献方法学质量评价全部为B级。2.纳入研究的姑息护理对象共3407人,包括癌症患者(90.3%)、非恶性疾病患者(7.3%)及患者家属(2.3%);且94.3%的研究对象来自住院患者,其余来自于社区。姑息护理的实施者包括护士(92.3%)、医生(53.8%)、患者家属(15.4%)、心理治疗师(12.8%)、康复治疗师(5.12%)、社会工作者(5.12%)及志愿者(5.12%);仅5%的实施者接受了专业化培训,22.5%实施者是由多种学科的人员组成的姑息护理团队。姑息护理的内容比较全面,主要的护理措施是:控制症状(85%)、心理护理(80%)、支持家属(47.5%)、基础护理(45%)及死亡教育(42.5%)。评价指标丰富多样,包括生存质量、心理状况、症状控制、患者满意度及其他五大方面。3.癌症患者姑息护理干预的效果(1)生活质量:姑息护理干预后2周、3周、4周、8周及12周时,其合并效应量分别为[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)心理状况:姑息护理干预后2周、4周、8周及12周时,对患者焦虑情绪影响的合并效应量分别为[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];姑息护理干预后2周、12周时,对患者抑郁情绪影响的合并效应量分别为[smd=-1.00,95%ci(-2.08,0.09),p=0.07][smd=-1.55,95%ci(-2.72,-0.38),p0.0001](3)症状:描述性分析结果显示姑息护理组疲乏、疼痛程度较对照组减轻(p0.01或p0.05)。(4)患者满意度:描述性分析结果显示姑息护理组患者满意度高于对照组(P0.01或P0.05)。4.非恶性疾病患者姑息护理的干预效果:描述性分析结果显示姑息护理组生存质量、心理状况、症状控制、满意度均优于对照组(P0.01或P0.05)。结论:1.姑息护理研究在国内得到广泛关注,但相关研究的方法学质量不高,均为中等。2.我国姑息护理研究的对象仍以癌症患者为主,对非恶性疾病患者及患者家属的关注较少;研究的样本量相对全国现有患病人数较小,代表性较弱;姑息护理的内容及评价指标较全面,但相对缺乏专业的姑息护理团队。3.姑息护理短期内能够提高癌症患者的生存质量,改善焦虑抑郁情绪,缓解疼痛、疲乏症状,提高患者满意度。4.姑息护理对非恶性疾病患者的生存质量、心理状况、症状控制等方面均有一定的促进作用,但还需要大样本的严格设计的随机对照试验加以佐证。5.姑息护理对患者家属干预效果由于纳入文献的数量过少而不能得到肯定的结论。
[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.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R47

【参考文献】