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

【摘要】：目的利用文獻(xiàn)計量學(xué)的方法對我國學(xué)者發(fā)表的臨床護(hù)理路徑研究文獻(xiàn)進(jìn)行可視化的分析以評價我國臨床護(hù)理路徑研究現(xiàn)狀,采用Meta分析評價臨床護(hù)理路徑對宮頸癌手術(shù)患者效果的影響,采用非隨機(jī)同期對照試驗(yàn)評價臨床護(hù)理路徑在宮頸癌手術(shù)患者中應(yīng)用的成本效果。方法(1)臨床護(hù)理路徑研究現(xiàn)狀分析:計算機(jī)檢索PubMed、EMBASE.com、Web of Science、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫、中國知網(wǎng)、萬方數(shù)據(jù)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(biāo)準(zhǔn)獨(dú)立篩選出臨床護(hù)理路徑的研究,用BICOMS 2分析軟件對關(guān)鍵詞進(jìn)行抽取和整理并生成共現(xiàn)矩陣,同時,分別利用NetDraw2.084和gCLUTO1.0分別繪制網(wǎng)絡(luò)關(guān)系圖和進(jìn)行聚類分析。(2)臨床護(hù)理路徑對宮頸癌手術(shù)患者的效果的Meta分析:計算機(jī)檢索Cochrane Library、PubMed、EMBASE.com、Web of science、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫、中國知網(wǎng)、萬方數(shù)據(jù)庫,并輔助其他檢索,檢索時間截止2016年9月,依據(jù)納入排除標(biāo)準(zhǔn)納入護(hù)理路徑對宮頸癌患者影響的隨機(jī)對照試驗(yàn),依據(jù)Cochrane偏倚風(fēng)險評估工具對納入文獻(xiàn)進(jìn)行質(zhì)量評價,并用STATA13.0進(jìn)行Meta分析。(3)臨床護(hù)理路徑應(yīng)用于宮頸癌手術(shù)患者的成本效果分析:采用非隨機(jī)同期對照試驗(yàn)設(shè)計,根據(jù)納入排除標(biāo)準(zhǔn)篩選蘭州大學(xué)第一醫(yī)院婦科收治的需宮頸癌手術(shù)的患者。根據(jù)患者自愿分為臨床護(hù)理路徑組與常規(guī)護(hù)理組,比較兩組患者在住院時間、術(shù)后并發(fā)癥、住院總費(fèi)用、護(hù)理費(fèi)、患者滿意度方面的差異,采用SPSS19.0軟件對數(shù)據(jù)進(jìn)行統(tǒng)計分析。結(jié)果(1)初檢獲得臨床護(hù)理路徑相關(guān)文獻(xiàn)10384篇,最終納入臨床護(hù)理路徑相關(guān)研究7323篇,研究數(shù)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(tuán)體,研究人員眾多,作者之間存在一定的聯(lián)系,但合作有待加強(qiáng),研究主題主要有8個。(2)共納入11個隨機(jī)對照試驗(yàn),Meta分析結(jié)果顯示:與常規(guī)護(hù)理相比,臨床護(hù)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(shù)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(hù)理路徑組患者48例,常規(guī)護(hù)理組48例,臨床護(hù)理路徑組和常規(guī)護(hù)理組在平均住院日(9.23±0.12天vs 12.20±3.10天)、總住院費(fèi)(17830.61±2582.14元vs 22514.15±1809.09元)、護(hù)理費(fèi)(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(xué)意義,術(shù)后并發(fā)癥方面的差異無統(tǒng)計學(xué)意義。成本效果分析結(jié)果顯示,與常規(guī)護(hù)理相比臨床護(hù)理路徑在患者住院總費(fèi)用/滿意度(182.09元/%vs 263.6元/%)和患者護(hù)理費(fèi)/滿意度(1.9元/%vs 3.28元/%)具有優(yōu)勢。結(jié)論我國臨床護(hù)理路徑的研究數(shù)量呈增長趨勢,且參與作者眾多,但核心作者數(shù)量少,且作者的合作仍需進(jìn)一步增強(qiáng),研究主題仍需進(jìn)一步拓展;對宮頸癌手術(shù)患者實(shí)施臨床護(hù)理路徑干預(yù),可縮短平均住院時間,減少術(shù)后并發(fā)癥,也提高了患者的滿意度;臨床護(hù)理路徑可以縮短住院時間、降低住院總費(fèi)用和護(hù)理費(fèi),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(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.73

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