我国临床护理路径在宫颈癌手术患者中应用的效果评价

发布时间：2018-05-07 08:18

本文选题：宫颈癌 + 临床护理路径　；参考：《兰州大学》2017年硕士论文

【摘要】：目的利用文献计量学的方法对我国学者发表的临床护理路径研究文献进行可视化的分析以评价我国临床护理路径研究现状,采用Meta分析评价临床护理路径对宫颈癌手术患者效果的影响,采用非随机同期对照试验评价临床护理路径在宫颈癌手术患者中应用的成本效果。方法(1)临床护理路径研究现状分析:计算机检索PubMed、EMBASE.com、Web of Science、中国生物医学文献数据库、中国知网、万方数据库,检索时间截止2017年1月。由2位研究者按照纳入与排除标准独立筛选出临床护理路径的研究,用BICOMS 2分析软件对关键词进行抽取和整理并生成共现矩阵,同时,分别利用NetDraw2.084和gCLUTO1.0分别绘制网络关系图和进行聚类分析。(2)临床护理路径对宫颈癌手术患者的效果的Meta分析:计算机检索Cochrane Library、PubMed、EMBASE.com、Web of science、中国生物医学文献数据库、中国知网、万方数据库,并辅助其他检索,检索时间截止2016年9月,依据纳入排除标准纳入护理路径对宫颈癌患者影响的随机对照试验,依据Cochrane偏倚风险评估工具对纳入文献进行质量评价,并用STATA13.0进行Meta分析。(3)临床护理路径应用于宫颈癌手术患者的成本效果分析:采用非随机同期对照试验设计,根据纳入排除标准筛选兰州大学第一医院妇科收治的需宫颈癌手术的患者。根据患者自愿分为临床护理路径组与常规护理组,比较两组患者在住院时间、术后并发症、住院总费用、护理费、患者满意度方面的差异,采用SPSS19.0软件对数据进行统计分析。结果(1)初检获得临床护理路径相关文献10384篇,最终纳入临床护理路径相关研究7323篇,研究数量在期刊、作者、省份分布方面不平衡,主要作者分为6个主要的研究团体,研究人员众多,作者之间存在一定的联系,但合作有待加强,研究主题主要有8个。(2)共纳入11个随机对照试验,Meta分析结果显示:与常规护理相比,临床护理路径可以缩短平均住院时间[WMD=-4.75(95%CI:-5.83~-3.67),P=0.000],减少术后的并发症发生率[OR=0.23(95%CI:0.15~0.36),P=0.000],提高患者的满意度[OR=6.32(95%CI:3.86~10.34),P=0.000]。(3)共纳入临床护理路径组患者48例,常规护理组48例,临床护理路径组和常规护理组在平均住院日(9.23±0.12天vs 12.20±3.10天)、总住院费(17830.61±2582.14元vs 22514.15±1809.09元)、护理费(185.70±247.9元vs 280.28±213.94元)和患者满意度(97.92%vs 85.41%)方面的差异有统计学意义,术后并发症方面的差异无统计学意义。成本效果分析结果显示,与常规护理相比临床护理路径在患者住院总费用/满意度(182.09元/%vs 263.6元/%)和患者护理费/满意度(1.9元/%vs 3.28元/%)具有优势。结论我国临床护理路径的研究数量呈增长趋势,且参与作者众多,但核心作者数量少,且作者的合作仍需进一步增强,研究主题仍需进一步拓展;对宫颈癌手术患者实施临床护理路径干预,可缩短平均住院时间,减少术后并发症,也提高了患者的满意度;临床护理路径可以缩短住院时间、降低住院总费用和护理费,提高患者的满意度,同时具有很好的成本效果。
[Abstract]:Objective to make a visual analysis of the literature of clinical nursing pathway published by Chinese scholars by bibliometrics to evaluate the status of clinical nursing path research in China, and to evaluate the effect of clinical nursing path on the effect of cervical cancer patients by Meta analysis, and to evaluate the clinical nursing path by non randomized concurrent control test. Cost effectiveness applied in patients with cervical cancer surgery. Method (1) analysis of the status of clinical nursing path research: computer retrieval of PubMed, EMBASE.com, Web of Science, Chinese biomedical literature database, Chinese knowledge network, Wanfang database, and the deadline of January 2017. The 2 researchers selected the independent criteria according to the inclusion and exclusion criteria. The study of bed nursing path, using BICOMS 2 analysis software to extract and organize the key words and generate co occurrence matrix. At the same time, NetDraw2.084 and gCLUTO1.0 are used to plot network relations and cluster analysis respectively. (2) Meta analysis of the effect of clinical nursing path on patients with cervical cancer: the computer retrieval of Cochrane Library, PubM Ed, EMBASE.com, Web of science, Chinese biomedical literature database, Chinese knowledge network, Wanfang database, and auxiliary retrieval, retrieval time cut-off September 2016, according to the inclusion of exclusion criteria into the nursing path to cervical cancer patients' impact of randomized controlled trials, according to the Cochrane bias risk assessment tool for the quality of the literature to be included in the quality of the literature Evaluation and Meta analysis with STATA13.0. (3) the cost-effectiveness analysis of the clinical nursing pathway applied to the patients with cervical cancer: a non randomized concurrent control trial was designed to screen the patients who need cervical cancer surgery in First Hospital Affiliated to Lanzhou University, according to the exclusion criteria. The routine nursing group compared the time of hospitalization, postoperative complications, the total cost of hospitalization, the total cost of hospitalization, the nursing fee and the patient satisfaction. The data were statistically analyzed by SPSS19.0 software. Results (1) 10384 articles were obtained from the first examination of clinical nursing path, and 7323 articles were included in the clinical nursing path, and the quantity was studied in the period of time. The distribution of the provinces is unbalanced. The main author is divided into 6 main research groups, there are many researchers and there are some connections between the authors, but the cooperation needs to be strengthened and the main topics are 8. (2) 11 randomized controlled trials have been included. The Meta analysis results show that the clinical nursing path can be shortened by comparison with conventional nursing. The average hospitalization time [WMD=-4.75 (95%CI:-5.83~-3.67), P=0.000], reduce the incidence of postoperative complications [OR=0.23 (95%CI:0.15~0.36), P=0.000], improve the patient's satisfaction [OR=6.32 (95%CI:3.86~10.34), P=0.000]. (3) were included in the clinical nursing path group of 48 cases, routine nursing group 48 cases, clinical nursing path group and routine care group in the average stay The hospital day (9.23 + 0.12 days vs 12.20 + 3.10 days), total hospitalization fee (17830.61 + 2582.14 yuan vs 22514.15 + 1809.09 yuan), nursing fee (185.70 + 247.9 yuan vs 280.28 + 213.94) and patient satisfaction (97.92%vs 85.41%) have statistical significance. There is no statistically significant difference in the square surface of postoperative complications. Compared with the clinical nursing path, the total cost / satisfaction (182.09 yuan /%vs 263.6 yuan /%) and the patient care fee / satisfaction (1.9 yuan /%vs 3.28 yuan /%) are superior to the clinical nursing path. Conclusion the number of clinical nursing paths in China is increasing, and the number of the authors is numerous, but the number of the core authors is few, and the cooperation of the authors still needs to be further studied. The clinical nursing path intervention for patients with cervical cancer surgery can shorten the average time of hospitalization, reduce the postoperative complications and improve the satisfaction of the patients. The clinical nursing path can shorten the time of hospitalization, reduce the total hospitalization expenses and nursing costs, improve the patient's satisfaction, and be very good at the same time. The cost effect.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73

【参考文献】