本文選題：宮頸癌 + 臨床護理路徑��； 參考：《蘭州大學》2017年碩士論文

【摘要】：目的利用文獻計量學的方法對我國學者發(fā)表的臨床護理路徑研究文獻進行可視化的分析以評價我國臨床護理路徑研究現狀,采用Meta分析評價臨床護理路徑對宮頸癌手術患者效果的影響,采用非隨機同期對照試驗評價臨床護理路徑在宮頸癌手術患者中應用的成本效果。方法(1)臨床護理路徑研究現狀分析:計算機檢索PubMed、EMBASE.com、Web of Science、中國生物醫(yī)學文獻數據庫、中國知網、萬方數據庫,檢索時間截止2017年1月。由2位研究者按照納入與排除標準獨立篩選出臨床護理路徑的研究,用BICOMS 2分析軟件對關鍵詞進行抽取和整理并生成共現矩陣,同時,分別利用NetDraw2.084和gCLUTO1.0分別繪制網絡關系圖和進行聚類分析。(2)臨床護理路徑對宮頸癌手術患者的效果的Meta分析:計算機檢索Cochrane Library、PubMed、EMBASE.com、Web of science、中國生物醫(yī)學文獻數據庫、中國知網、萬方數據庫,并輔助其他檢索,檢索時間截止2016年9月,依據納入排除標準納入護理路徑對宮頸癌患者影響的隨機對照試驗,依據Cochrane偏倚風險評估工具對納入文獻進行質量評價,并用STATA13.0進行Meta分析。(3)臨床護理路徑應用于宮頸癌手術患者的成本效果分析:采用非隨機同期對照試驗設計,根據納入排除標準篩選蘭州大學第一醫(yī)院婦科收治的需宮頸癌手術的患者。根據患者自愿分為臨床護理路徑組與常規(guī)護理組,比較兩組患者在住院時間、術后并發(fā)癥、住院總費用、護理費、患者滿意度方面的差異,采用SPSS19.0軟件對數據進行統(tǒng)計分析。結果(1)初檢獲得臨床護理路徑相關文獻10384篇,最終納入臨床護理路徑相關研究7323篇,研究數量在期刊、作者、省份分布方面不平衡,主要作者分為6個主要的研究團體,研究人員眾多,作者之間存在一定的聯系,但合作有待加強,研究主題主要有8個。(2)共納入11個隨機對照試驗,Meta分析結果顯示:與常規(guī)護理相比,臨床護理路徑可以縮短平均住院時間[WMD=-4.75(95%CI:-5.83~-3.67),P=0.000],減少術后的并發(fā)癥發(fā)生率[OR=0.23(95%CI:0.15~0.36),P=0.000],提高患者的滿意度[OR=6.32(95%CI:3.86~10.34),P=0.000]。(3)共納入臨床護理路徑組患者48例,常規(guī)護理組48例,臨床護理路徑組和常規(guī)護理組在平均住院日(9.23±0.12天vs 12.20±3.10天)、總住院費(17830.61±2582.14元vs 22514.15±1809.09元)、護理費(185.70±247.9元vs 280.28±213.94元)和患者滿意度(97.92%vs 85.41%)方面的差異有統(tǒng)計學意義,術后并發(fā)癥方面的差異無統(tǒng)計學意義。成本效果分析結果顯示,與常規(guī)護理相比臨床護理路徑在患者住院總費用/滿意度(182.09元/%vs 263.6元/%)和患者護理費/滿意度(1.9元/%vs 3.28元/%)具有優(yōu)勢。結論我國臨床護理路徑的研究數量呈增長趨勢,且參與作者眾多,但核心作者數量少,且作者的合作仍需進一步增強,研究主題仍需進一步拓展;對宮頸癌手術患者實施臨床護理路徑干預,可縮短平均住院時間,減少術后并發(fā)癥,也提高了患者的滿意度;臨床護理路徑可以縮短住院時間、降低住院總費用和護理費,提高患者的滿意度,同時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.

【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.73

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