乳腺癌术后淋巴水肿预防行为临床实践指南初步构建

发布时间：2018-04-27 02:17

本文选题：乳腺癌 + 淋巴水肿　；参考：《安徽医科大学》2017年硕士论文

【摘要】：研究背景乳腺癌居我国女性癌症发病的第一位,且我国已成为世界上增长速度最快的国家之一,而淋巴水肿是其严重的并发症,通过相关预防行为的执行可以有效降低乳腺癌术后淋巴水肿的发生率,目前国内尚无以循证为基础的乳腺癌术后淋巴水肿预防行为规范,为医护人员及患者提供规范化指导。因此,应结合现有最佳证据构建具临床指导意义的乳腺癌术后淋巴水肿预防行为临床实践指南。目的调查并分析医护人员及乳腺癌术后患者对乳腺癌术后淋巴水肿预防行为认知、执行现状、现存问题,整合现有最佳证据、系统评价及相关指南等循证资源初步构建基于循证的《乳腺癌术后淋巴水肿预防行为临床实践指南》。方法采用问卷调查和半结构式个人深入访谈结合的方式,深入了解并分析乳腺癌术后患者及医护人员其乳腺癌术后淋巴水肿预防行为现状及存在问题,运用Meta分析、系统评价和指南内容分析整合现有最佳证据,指南制定小组成员根据以上结果构建乳腺癌术后淋巴水肿预防行为临床实践指南草案及指导手册。结果1.在安徽省某四所三甲医院乳腺外科、肿瘤科对272例乳腺癌术后患者进行问卷调查,对19例乳腺癌术后患者和16位医护人员进行半结构式个人深入访谈发现当前乳腺癌术后淋巴水肿预防行为缺乏具体的规范指导、患者的知晓率差、医护人员的重视程度参差不齐和工作负荷较重等问题。2.全面检索数据库并对符合纳入标准的文献质量进行严格评鉴,最终纳入24篇随机对照实验研究,文献质量处于中等及以上水平,对不同乳腺癌术后淋巴水肿预防行为进行归类并进行Meta分析,其中空气波压力治疗仪、自制软枕、艾灸疗法及个性化功能锻炼等预防行为可有效降低淋巴水肿的发生率。经描述性分析口腔负压吸引、患侧上肢加压和推拿疗法等预防行为可以有效改善肢体肿胀程度及活动度,为构建指南提供证据支持。3.全面检索各指南网站及数据库,最终共纳入5项乳腺癌术后淋巴水肿预防行为相关临床实践指南其推荐意见和应用说明主要包括锻炼、压缩服装的使用、感染的处理和皮肤护理等16项,为构建指南提供了证据支持。4.指南制定小组成员结合量性研究、质性研究、系统评价和相关指南内容分析研究结果构建《乳腺癌术后淋巴水肿预防行为临床实践指南》草案及指导手册。结论1.当前乳腺癌术后淋巴水肿预防行为缺乏科学、规范和有效的指导。2.《乳腺癌术后淋巴水肿预防行为临床实践指南》共22条推荐建议,主要内容为空气波压力治疗仪、自制软枕、艾灸疗法、压缩服装的使用和感染(蜂窝织炎)的处理等,是基于循证的、以乳腺癌术后患者问卷调查、医护人员和乳腺癌术后患者半结构式个人深入访谈、系统评价和指南内容分析为依据构建的指南。
[Abstract]:Background Breast cancer ranks first in the incidence of female cancer in China, and China has become one of the fastest growing countries in the world, and lymphedema is a serious complication. The incidence of postoperative lymphedema in breast cancer can be effectively reduced through the implementation of related preventive behaviors. At present, there is no evidence-based behavior standard for prevention of lymphedema after breast cancer surgery in China, which provides standardized guidance for medical staff and patients. Therefore, the best available evidence should be combined to establish clinical practice guidelines for the prevention of lymphedema after breast cancer surgery. Objective to investigate and analyze the health care workers and patients with breast cancer after operation on the prevention of lymphedema behavior awareness, implementation status, existing problems, the integration of the best available evidence, Evidence-based resources such as systematic evaluation and related guidelines were preliminarily constructed based on evidence-based guidelines for the prevention of lymphedema after breast cancer. Methods the present situation and problems of lymphedema prevention of breast cancer patients and health care workers after operation were analyzed by means of questionnaire survey and semi-structured personal in-depth interview. Meta analysis was used to analyze the prevention behavior of lymphedema after breast cancer operation. Systematic evaluation and content analysis of the guidelines integrate the best available evidence and guide team members to build draft guidelines and guidance manuals for clinical practice in the prevention of lymphedema after breast cancer surgery based on the above results. Result 1. A questionnaire survey was conducted in the Department of Oncology in four third Class A Hospitals in Anhui Province on 272 patients with breast cancer after surgery. 19 cases of postoperative breast cancer patients and 16 medical staff were interviewed with semi-structured individuals. It was found that the prevention of lymphedema after breast cancer operation lacked specific normative guidance, and the awareness rate of patients was poor. Health care workers pay attention to the degree of uneven and heavy workload and other issues. 2. Comprehensive retrieval of the database and strict evaluation of the quality of the literature that met the inclusion criteria were carried out. Finally, 24 randomized controlled experimental studies were conducted, and the quality of the literature was at a medium level or above. The prevention behaviors of lymphedema after operation of different breast cancer were classified and analyzed by Meta. Among them, air wave pressure therapy, self-made soft pillow, moxibustion therapy and individualized functional exercise could effectively reduce the incidence of lymphedema. Descriptive analysis of oral negative pressure attraction, upper limb compression and massage therapy can effectively improve the degree of limb swelling and mobility, and provide evidence to support the construction guidelines. 3. Search all the websites and databases of the guidelines, and finally include 5 clinical practice guidelines related to the prevention of lymphedema after breast cancer. Their recommendations and application instructions mainly include the use of exercise, compression clothing, etc. Sixteen items, including treatment of infection and skin care, provide evidence to support the construction guidelines. Guide-making team members combined quantitative, qualitative, systematic evaluation, and related guidelines to analyze the results of the study to build a draft of the "guidelines for Clinical practice in the Prevention of lymphedema behavior after Breast Cancer" and a guide manual. Conclusion 1. At present, the prevention of postoperative lymphedema of breast cancer lacks scientific, standardized and effective guidance .2.The guidelines for clinical practice of prevention of lymphedema after breast cancer have 22 recommendations, the main contents of which are air wave pressure therapy instrument and self-made soft pillow. Moxibustion therapy, the use of compressed clothing, and the treatment of infection (cellulitis) are based on evidence-based questionnaire surveys of patients after breast cancer surgery, in-depth interviews between medical and nursing staff and semi-structured individuals after breast cancer surgery, System evaluation and guide content analysis as the basis for the construction of the guide.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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