本文選題：兒童 + 延續(xù)護理��； 參考：《重慶醫(yī)科大學》2017年碩士論文

【摘要】：目的系統(tǒng)評價延續(xù)護理在兒科護理實施中的現(xiàn)狀及效果,探討其有效性,為兒科循證護理衛(wèi)生決策提供依據(jù)。總結目前研究涉及的兒科疾病病種、延續(xù)護理模式及干預效果、研究數(shù)量變化、地區(qū)分布等,探討延續(xù)護理在兒科護理領域?qū)嵤┑男ЧF(xiàn)狀及問題,為構建規(guī)范化的兒科延續(xù)護理方案提供循證科學依據(jù)。方法檢索Pub Med、EBSCOhost、Elsevier、中國生物醫(yī)學文獻數(shù)據(jù)庫(CBM)、中國知識資源總庫(CNKI)、維普中文科技期刊數(shù)據(jù)庫(VIP)、萬方醫(yī)學數(shù)據(jù)網(wǎng)中關于國內(nèi)兒童延續(xù)護理的隨機對照試驗(RCT)、臨床對照試驗(CCT)、交叉試驗,檢索范圍限定為建庫至2016年12月。嚴格按照納入和排除標準,由2名系統(tǒng)評價研究員獨立篩選文獻、評價納入研究的偏倚風險以及提取數(shù)據(jù)資料,由第三方對研究分歧進行判斷,統(tǒng)計分析采用Rev Man5.3軟件進行Meta分析。結果1.通過檢索,共篩選出233個國內(nèi)患病兒童延續(xù)護理的研究,研究數(shù)量自2003年開始呈逐年增長趨勢,近十年(2007年~2016年)發(fā)表研究220篇,占此類研究總數(shù)的94.42%。所涉及的病種達28種,數(shù)量較多的為兒童哮喘(38.2%)、早產(chǎn)兒(22.32%)、腎病綜合征(9.01%)、腦性癱瘓(6.44%)。2.本系統(tǒng)評價共納入35個研究,其中早產(chǎn)兒研究15個(10個RCT個,5個CCT研究),兒童哮喘研究20個(18個RCT研究,2個CCT研究)。涉及研究對象的總例數(shù)為3589例,有24個研究延續(xù)護理干預時間達6個月以上。3.早產(chǎn)兒延續(xù)護理的干預效果:(1)早產(chǎn)兒生長發(fā)育(身長、體重、頭圍):6月時,加權均數(shù)差(Weighted Mean Difference,WMD)=0.73,95%CI(0.58,0.88),P0.00001;12月時,WMD=0.32,95%CI(0.18,0.45),P0.00001差異有統(tǒng)計學意義。(2)早產(chǎn)兒發(fā)育商(Developmental quotient,DQ):WMD=7.76,95%CI(7.26,8.27),P0.00001差異有統(tǒng)計學意義。(3)早產(chǎn)兒再入院情況:OR=0.2,95%CI(0.11,0.35),P0.00001差異有統(tǒng)計學意義。(4)早產(chǎn)兒出院后患病率:OR=0.19,95%CI(0.12,0.28),P0.00001差異有統(tǒng)計學意義。(5)出院后母乳喂養(yǎng)情況:OR=19.21,95%CI(3.59,102.72),P=0.0006差異有統(tǒng)計學意義。4.哮喘患兒延續(xù)護理干預效果:(1)兒童肺功能(第1秒用力呼氣量占預計值的百分比,FEV1%):6月時,WMD=1.16,95%CI(-0.12,2.53),P=0.1,差異無統(tǒng)計學意義;1年時,WMD=1.77,95%CI(0.82,2.71),P=0.0003,差異有統(tǒng)計學意義。(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,差異有統(tǒng)計學意義。(3)兒童生活質(zhì)量:圣喬治呼吸問卷(SGRQ)WMD=-15.28,95%CI(-16.61,-13.94),P0.00001差異有統(tǒng)計學意義;標準兒童哮喘生活質(zhì)量評分(Standardized Pediatric Asthma Quality of Life Questionnaire-Mandarin,PAQLQ)WMD=7.45,95%CI(6.00,8.89),P0.00001差異有統(tǒng)計學意義。結論1.目前,延續(xù)護理在國內(nèi)兒科護理領域已得到廣泛關注,自2011年開始研究數(shù)量增長趨勢明顯,研究所涉及兒科疾病達28余種,主要以慢性疾病為主。2.目前較多關于早產(chǎn)兒、哮喘患兒的延續(xù)護理干預研究。3.延續(xù)護理干預促進早產(chǎn)兒體格生長發(fā)育及智能發(fā)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養(yǎng)率。4.延續(xù)護理干預有效改善哮喘患兒肺功能,提高其哮喘控制水平,提升患兒生活質(zhì)量。5.兒科延續(xù)護理未形成系統(tǒng)的服務流程,干預評價指標不統(tǒng)一,干預模式與發(fā)達國家相比有待提高。醫(yī)護人員應在充分結合國內(nèi)現(xiàn)狀情況的基礎上,構建有助于兒童康復的延續(xù)護理模式。
[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.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.72

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