基于系统评价与Delphi法构建骨科大手术患者深静脉血栓的护理预防策略研究

发布时间：2018-05-04 19:34

本文选题：静脉血栓形成 + 系统评价　；参考：《南京中医药大学》2017年硕士论文

【摘要】：研究目的:①本次研究基于前期文献回顾,采用系统评价法循证骨科大手术患者深静脉血栓护理预防策略的最佳证据,结合课题前期多中心横断面调研现状,对证据进行归纳、整合,初步构建Delphi专家函询表,为骨科大手术患者系统预防策略的建立提供充实的理论依据;②采用初步构建的专家函询表,提交Delphi专家函询,构建可供临床护理实践借鉴参考的骨科大手术患者围手术期深静脉血栓预防策略,用于指导护理实际具体情境,为医院骨科大手术患者深静脉血栓的护理预防策略的实施提供循证依据和实践指导,降低血栓发生率。研究对象与方法:采用系统评价法计算机系统检索澳大利亚PEDro、美国医师协会指南库、澳大利亚临床实践指南门户网站、美国卫生保健质量和研究机构、加拿大安大略注册护士协会等临床实践指南资源以及Cochrance Library、Pubmed、Embase、中国生物医学文献数据库CBMWeb(1978-)、万方数据库Wangfang Data、中文期刊全文数据库(CNKI)等数据库。检索时限为建库时间至2015年12月31日。联合主题词与自由词,拟定系统的文献检索策略,运用该系统的策略检索文献,对检索出的文献,采用澳大利亚JBI2008循证卫生保健中心和Johns Hopkins的文献质量评鉴和证据分级标准,总结归纳出骨科大手术患者深静脉血栓相关护理预防措施,初拟护理预防策略问卷,问卷中包含各条目证据等级、文献质量及相关附录供专家在函询时参考。运用Delphi法,选取来自南京、苏州、扬州、无锡、南通等14所三级甲等综合医院,共19位骨科、血管外科、普通外科等临床医疗及护理专家,对策略中各条目的重要性、可操作性等进行评分,并给出具体的条目删除、修改等专家意见。通过两轮征询,各位专家结合临床应用实际反馈临床意见,结合已制定的条目筛选指标,对预防策略进行调整修订;经查阅文献和课题组分析,根据研究的实际情况,条目筛选标准为条目重要性和可操作性赋值均数≥3.5,且变异系数(CV)0.3。同时符合以上条件时入选,若只有一项符合,课题组根据科学性、实用性、可应用性原则,结合专家函询意见,再讨论后决定修改、删除或增加相关预防策略,最终确立第二轮函询的条目。运用优序图法建立矩阵,确定一级条目的权重,同时依据各专家对二级和三级条目的重要性赋值均数评分法确定二、三级条目权重,采用连乘积法确定其权重及组合权重系数。统计分析使用Microsoft Excel 2007建立数据库和SPSS21.0统计软件包实施统计分析,全部数据经双人核对录入。采用统计描述和非参数检验法计算算术均数(X)、标准差(S)、变异系数(CV)、Kendall's协调系数(W)等,并进行显著性检验,P0.05提示有统计学意义。研究结果:111篇文献纳入最终研究,经由系统评价法,构建了包涵"风险评估""分级预防" "教育指导"在内的3个维度、52项骨科大手术深静脉血栓护理预防策略,主要包含三级条目的证据等级、文献质量及参考附录。随后进行2轮专家函询,调整条目4项、删除条目3项,最后确立3维度49条目的骨科大手术患者深静脉血栓的护理预防策略。2轮函询的问卷有效回收率依次为95%、100%,提出建议的专家比率依次为42.1%、26.3%,专家权威系数依次为0.85、0.87;第二轮CV波动在0%-23.38%,协调系数W分别为0.280、0.407,显著性检验结果提示P0.000,表明该策略研究方法科学,函询结果协调、可靠,最终构建的证据策略具有可操作性,便于临床证据参考和应用。研究结论:基于系统评价和Delphi法构建的骨科大手术患者深静脉血栓护理预防策略具有较高的科学实用性和可操作性,可为临床护理及实践操作提供客观、可借鉴的实施策略,有利于有效深静脉血栓预防措施的实施。
[Abstract]:The purpose of this study is: (1) based on the previous literature review, the best evidence for the prevention strategy of deep venous thrombosis in the evidence-based Department of orthopedics with the system evaluation method was adopted, and the evidence was summarized, integrated, and the Delphi expert questionnaire was constructed to prevent the patients in the large operation of the Department of orthopedics. The establishment of the strategy provides a substantial theoretical basis; secondly, a preliminary constructed expert correspondence form is adopted to submit the Delphi expert inquiry to construct the perioperative deep venous thrombosis prevention strategy for the patients in the Department of orthopedics, which can be used for reference in the clinical nursing practice for reference, and to guide the actual situation of nursing in the actual situation of the nursing, and to provide the deep venous thrombosis in the large operation patients in the hospital department of orthopedics. The implementation of nursing prevention strategies provides evidence-based and practical guidance to reduce the incidence of thrombus. Research objects and methods: using system evaluation computer system to retrieve Australian PEDro, American physicians' Association Guide library, Australian clinical practice guide portal, American health care quality and Research Institute, Ontario, Canada Cochrance Library, Pubmed, Embase, Chinese biomedical literature database CBMWeb (1978-), Wanfang database Wangfang Data, Chinese journal full text database (CNKI) and other databases. The retrieval time limit is the time to December 31, 2015. Joint theme words and free words, draw up the literature of the system The retrieval strategy, using the system's strategy to retrieve the literature, and using the literature quality evaluation and the evidence grading standard of the Australian JBI2008 evidence-based health care center and Johns Hopkins, summed up the nursing precautions related to the deep venous thrombosis in the Department of orthopedics, the preliminary nursing prevention strategy questionnaire and the questionnaire. The level of evidence, the quality of the documents and the related appendices are provided for the experts to consult in the inquiry. By using the Delphi method, 14 three grade first class hospitals from Nanjing, Suzhou, Yangzhou, Wuxi and Nantong are selected, with a total of 19 Department of orthopedics, vascular surgery, general surgery and other clinical medical and nursing experts. Through two rounds of consultation, the experts combined with the clinical application to feed back the clinical opinions, combined with the selected items that have been selected to adjust and revise the prevention strategy. After consulting the literature and the research group analysis, the entry screening criteria are the entries. The value of importance and operability is equal to more than 3.5, and the coefficient of variation (CV) 0.3. conforms to the above conditions. If only one is consistent, the subject group is based on the scientific, practical, applicable principle, the expert inquiry and the discussion, then decides to modify, delete or increase the related prevention strategy, and finally establish the second round inquiry entry. Using the optimal sequence diagram method, the matrix is established, and the weight of the first order is determined. At the same time, the weight of the two and the three level entries is determined according to the importance value average score method of the two and three level items, and the weight and the combination weight coefficient are determined by the continuous product method. The statistical analysis uses the Microsoft Excel 2007 to establish the database and the SPSS21.0 statistical software. Statistical analysis was carried out. All data were checked and recorded by two people. Statistical description and non parametric test were used to calculate arithmetic mean (X), standard deviation (S), coefficient of variation (CV), Kendall's coordination coefficient (W) and so on, and a significant test was carried out. The results of P0.05 were statistically significant. The results of the study: 111 papers were included in the final study by systematic evaluation. 3 dimensions including "risk assessment" "graded prevention" and "education guidance" were included, and 52 nursing prevention strategies for deep venous thrombosis in the Department of orthopedics were included, including the grade of evidence of grade three, the quality of literature and the reference appendix. Then 2 rounds of expert consultation, 4 items were adjusted, 3 items were deleted, and the 3 dimensions and 49 purpose Department of orthopedics were finally established. The effective recovery rate of the.2 round inquiry was 95%, 100%, the expert ratio was 42.1%, 26.3%, and the expert authority coefficient was 0.85,0.87 in turn; the second round CV fluctuated in 0%-23.38%, and the coordination coefficient W was 0.280,0.407 respectively. The significant test results suggested P0.000, indicating the strategy. Research method science, correspondence results are coordinated and reliable, and the final construction evidence strategy is operable and convenient for clinical evidence reference and application. Conclusion: the nursing prevention strategy of deep venous thrombosis in Department of orthopedics based on systematic evaluation and Delphi method has high scientific practicality and maneuverability, and it can be used for clinical nursing and Practical operation provides an objective and effective implementation strategy, which is conducive to the implementation of effective preventive measures for deep venous thrombosis.

【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6

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