儿科护理中实施延续护理干预的系统评价

发布时间：2018-07-07 15:03

本文选题：儿童 + 延续护理　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的系统评价延续护理在儿科护理实施中的现状及效果,探讨其有效性,为儿科循证护理卫生决策提供依据。总结目前研究涉及的儿科疾病病种、延续护理模式及干预效果、研究数量变化、地区分布等,探讨延续护理在儿科护理领域实施的效果、现状及问题,为构建规范化的儿科延续护理方案提供循证科学依据。方法检索Pub Med、EBSCOhost、Elsevier、中国生物医学文献数据库(CBM)、中国知识资源总库(CNKI)、维普中文科技期刊数据库(VIP)、万方医学数据网中关于国内儿童延续护理的随机对照试验(RCT)、临床对照试验(CCT)、交叉试验,检索范围限定为建库至2016年12月。严格按照纳入和排除标准,由2名系统评价研究员独立筛选文献、评价纳入研究的偏倚风险以及提取数据资料,由第三方对研究分歧进行判断,统计分析采用Rev Man5.3软件进行Meta分析。结果1.通过检索,共筛选出233个国内患病儿童延续护理的研究,研究数量自2003年开始呈逐年增长趋势,近十年(2007年~2016年)发表研究220篇,占此类研究总数的94.42%。所涉及的病种达28种,数量较多的为儿童哮喘(38.2%)、早产儿(22.32%)、肾病综合征(9.01%)、脑性瘫痪(6.44%)。2.本系统评价共纳入35个研究,其中早产儿研究15个(10个RCT个,5个CCT研究),儿童哮喘研究20个(18个RCT研究,2个CCT研究)。涉及研究对象的总例数为3589例,有24个研究延续护理干预时间达6个月以上。3.早产儿延续护理的干预效果:(1)早产儿生长发育(身长、体重、头围):6月时,加权均数差(Weighted Mean Difference,WMD)=0.73,95%CI(0.58,0.88),P0.00001;12月时,WMD=0.32,95%CI(0.18,0.45),P0.00001差异有统计学意义。(2)早产儿发育商(Developmental quotient,DQ):WMD=7.76,95%CI(7.26,8.27),P0.00001差异有统计学意义。(3)早产儿再入院情况:OR=0.2,95%CI(0.11,0.35),P0.00001差异有统计学意义。(4)早产儿出院后患病率:OR=0.19,95%CI(0.12,0.28),P0.00001差异有统计学意义。(5)出院后母乳喂养情况:OR=19.21,95%CI(3.59,102.72),P=0.0006差异有统计学意义。4.哮喘患儿延续护理干预效果:(1)儿童肺功能(第1秒用力呼气量占预计值的百分比,FEV1%):6月时,WMD=1.16,95%CI(-0.12,2.53),P=0.1,差异无统计学意义;1年时,WMD=1.77,95%CI(0.82,2.71),P=0.0003,差异有统计学意义。(2)哮喘控制水平:WMD=4.07,95%CI(3.19,4.94),P0.00001;OR=6.07,95%CI(2.23,16.52),P=0.0004,差异有统计学意义。(3)儿童生活质量:圣乔治呼吸问卷(SGRQ)WMD=-15.28,95%CI(-16.61,-13.94),P0.00001差异有统计学意义;标准儿童哮喘生活质量评分(Standardized Pediatric Asthma Quality of Life Questionnaire-Mandarin,PAQLQ)WMD=7.45,95%CI(6.00,8.89),P0.00001差异有统计学意义。结论1.目前,延续护理在国内儿科护理领域已得到广泛关注,自2011年开始研究数量增长趋势明显,研究所涉及儿科疾病达28余种,主要以慢性疾病为主。2.目前较多关于早产儿、哮喘患儿的延续护理干预研究。3.延续护理干预促进早产儿体格生长发育及智能发育;降低了出院后的患病率和再入院率,提高了其居家母乳喂养率。4.延续护理干预有效改善哮喘患儿肺功能,提高其哮喘控制水平,提升患儿生活质量。5.儿科延续护理未形成系统的服务流程,干预评价指标不统一,干预模式与发达国家相比有待提高。医护人员应在充分结合国内现状情况的基础上,构建有助于儿童康复的延续护理模式。
[Abstract]:Objective to systematically evaluate the status and effect of continuous nursing in the implementation of paediatric nursing, to explore its effectiveness, to provide basis for the policy-making of paediatric evidence-based nursing health, to summarize the current research related to pediatric diseases, to continue the nursing mode and effect, to study the changes in quantity, and to explore the distribution of the region, and to explore the implementation of the continuation of nursing in the field of pediatric nursing. The results, status and problems provide evidence-based scientific basis for the construction of standardized paediatric continuation nursing program. Methods Pub Med, EBSCOhost, Elsevier, Chinese biomedical literature database (CBM), China's general database of knowledge resources (CNKI), VP Chinese sci-tech periodicals database (VIP), and the continuous nursing of domestic children in Wanfang medical data network A randomized controlled trial (RCT), a clinical controlled trial (CCT), a cross test, and a search range limited to December 2016. Strictly according to the inclusion and exclusion criteria, 2 systematic evaluation fellows screened the literature independently, evaluated the bias risk and extracted data from the study, and judged the differences between the third parties and statistical analysis. Rev Man5.3 software was used to carry out Meta analysis. Results 1. through retrieval, 233 studies on continuing care for children in sick children were screened. The number of studies began to increase year by year since 2003, and 220 articles were published in nearly ten years (2007), accounting for 94.42% of the total number of such studies. Asthma (38.2%), preterm (22.32%), nephrotic syndrome (9.01%) and cerebral palsy (6.44%).2. were evaluated in a total of 35 studies, including 15 preterm infants (10 RCT, 5 CCT Studies), 20 children's asthma study (18 RCT studies, 2 CCT Studies). The total number of subjects involved in the study was 3589, and there were 24 studies on the duration of nursing intervention. The effects of continuous nursing for.3. preterm infants over 6 months were: (1) the growth and development of preterm infants (body length, weight, head circumference): in June, the weighted mean number difference (Weighted Mean Difference, WMD) =0.73,95%CI (0.58,0.88), P0.00001; WMD=0.32,95%CI (0.18,0.45), P0.00001 differences in December were statistically significant. (2) the preterm child developmental quotient (Developmental) T, DQ): WMD=7.76,95%CI (7.26,8.27), P0.00001 differences were statistically significant. (3) preterm infants rehospitalization: OR=0.2,95%CI (0.11,0.35), P0.00001 difference was statistically significant. (4) the incidence of premature infants after discharge: OR=0.19,95%CI (0.12,0.28), P0.00001 difference is statistically significant. (5) breast feeding situation after discharge: OR=19.21,95%CI =0.0006 difference was statistically significant in the effect of continuous nursing intervention in children with.4. asthma: (1) children's pulmonary function (percentage of expected 1 second forced expiratory volume, FEV1%): in June, WMD=1.16,95%CI (-0.12,2.53), P=0.1, the difference was not statistically significant; at 1 years, WMD= 1.77,95%CI (0.82,2.71), P=0.0003, the difference was statistically significant. (2) the level of asthma control WMD=4.07,95%CI (3.19,4.94), P0.00001; OR=6.07,95%CI (2.23,16.52), P=0.0004, the difference was statistically significant. (3) the quality of life of children: the St Georges Respiratory Questionnaire (SGRQ) WMD=-15.28,95%CI (-16.61, -13.94), P0.00001 difference was statistically significant; Onnaire-Mandarin, PAQLQ) WMD=7.45,95%CI (6.00,8.89), P0.00001 difference has statistical significance. Conclusion 1. at present, continuous care in the field of domestic paediatric care has been widely concerned. Since 2011, the trend of quantitative growth has been obvious. The research institute involves more than 28 kinds of pediatric diseases, mainly with chronic diseases mainly.2. at present. Continuous nursing intervention in children with asthma:.3. continuous nursing intervention to promote physical growth and intelligent development of premature infants, reduce the incidence and readmission rate after discharge, and improve their home breastfeeding rate.4. continuous nursing intervention to effectively improve the lung function of children with asthma, improve the control level of asthma and improve the quality of life of the children. .5. paediatric continuation care has not formed a systematic service flow, the intervention evaluation index is not uniform, and the intervention model needs to be improved compared with the developed countries. The medical and nursing staff should build a continuous nursing model which is helpful to the rehabilitation of children on the basis of the situation in China.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.72

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