本文選題：靜脈血栓形成 + 系統(tǒng)評(píng)價(jià)　； 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：研究目的:①本次研究基于前期文獻(xiàn)回顧,采用系統(tǒng)評(píng)價(jià)法循證骨科大手術(shù)患者深靜脈血栓護(hù)理預(yù)防策略的最佳證據(jù),結(jié)合課題前期多中心橫斷面調(diào)研現(xiàn)狀,對(duì)證據(jù)進(jìn)行歸納、整合,初步構(gòu)建Delphi專家函詢表,為骨科大手術(shù)患者系統(tǒng)預(yù)防策略的建立提供充實(shí)的理論依據(jù);②采用初步構(gòu)建的專家函詢表,提交Delphi專家函詢,構(gòu)建可供臨床護(hù)理實(shí)踐借鑒參考的骨科大手術(shù)患者圍手術(shù)期深靜脈血栓預(yù)防策略,用于指導(dǎo)護(hù)理實(shí)際具體情境,為醫(yī)院骨科大手術(shù)患者深靜脈血栓的護(hù)理預(yù)防策略的實(shí)施提供循證依據(jù)和實(shí)踐指導(dǎo),降低血栓發(fā)生率。研究對(duì)象與方法:采用系統(tǒng)評(píng)價(jià)法計(jì)算機(jī)系統(tǒng)檢索澳大利亞PEDro、美國(guó)醫(yī)師協(xié)會(huì)指南庫(kù)、澳大利亞臨床實(shí)踐指南門戶網(wǎng)站、美國(guó)衛(wèi)生保健質(zhì)量和研究機(jī)構(gòu)、加拿大安大略注冊(cè)護(hù)士協(xié)會(huì)等臨床實(shí)踐指南資源以及Cochrance Library、Pubmed、Embase、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)CBMWeb(1978-)、萬(wàn)方數(shù)據(jù)庫(kù)Wangfang Data、中文期刊全文數(shù)據(jù)庫(kù)(CNKI)等數(shù)據(jù)庫(kù)。檢索時(shí)限為建庫(kù)時(shí)間至2015年12月31日。聯(lián)合主題詞與自由詞,擬定系統(tǒng)的文獻(xiàn)檢索策略,運(yùn)用該系統(tǒng)的策略檢索文獻(xiàn),對(duì)檢索出的文獻(xiàn),采用澳大利亞JBI2008循證衛(wèi)生保健中心和Johns Hopkins的文獻(xiàn)質(zhì)量評(píng)鑒和證據(jù)分級(jí)標(biāo)準(zhǔn),總結(jié)歸納出骨科大手術(shù)患者深靜脈血栓相關(guān)護(hù)理預(yù)防措施,初擬護(hù)理預(yù)防策略問(wèn)卷,問(wèn)卷中包含各條目證據(jù)等級(jí)、文獻(xiàn)質(zhì)量及相關(guān)附錄供專家在函詢時(shí)參考。運(yùn)用Delphi法,選取來(lái)自南京、蘇州、揚(yáng)州、無(wú)錫、南通等14所三級(jí)甲等綜合醫(yī)院,共19位骨科、血管外科、普通外科等臨床醫(yī)療及護(hù)理專家,對(duì)策略中各條目的重要性、可操作性等進(jìn)行評(píng)分,并給出具體的條目刪除、修改等專家意見。通過(guò)兩輪征詢,各位專家結(jié)合臨床應(yīng)用實(shí)際反饋臨床意見,結(jié)合已制定的條目篩選指標(biāo),對(duì)預(yù)防策略進(jìn)行調(diào)整修訂;經(jīng)查閱文獻(xiàn)和課題組分析,根據(jù)研究的實(shí)際情況,條目篩選標(biāo)準(zhǔn)為條目重要性和可操作性賦值均數(shù)≥3.5,且變異系數(shù)(CV)0.3。同時(shí)符合以上條件時(shí)入選,若只有一項(xiàng)符合,課題組根據(jù)科學(xué)性、實(shí)用性、可應(yīng)用性原則,結(jié)合專家函詢意見,再討論后決定修改、刪除或增加相關(guān)預(yù)防策略,最終確立第二輪函詢的條目。運(yùn)用優(yōu)序圖法建立矩陣,確定一級(jí)條目的權(quán)重,同時(shí)依據(jù)各專家對(duì)二級(jí)和三級(jí)條目的重要性賦值均數(shù)評(píng)分法確定二、三級(jí)條目權(quán)重,采用連乘積法確定其權(quán)重及組合權(quán)重系數(shù)。統(tǒng)計(jì)分析使用Microsoft Excel 2007建立數(shù)據(jù)庫(kù)和SPSS21.0統(tǒng)計(jì)軟件包實(shí)施統(tǒng)計(jì)分析,全部數(shù)據(jù)經(jīng)雙人核對(duì)錄入。采用統(tǒng)計(jì)描述和非參數(shù)檢驗(yàn)法計(jì)算算術(shù)均數(shù)(X)、標(biāo)準(zhǔn)差(S)、變異系數(shù)(CV)、Kendall's協(xié)調(diào)系數(shù)(W)等,并進(jìn)行顯著性檢驗(yàn),P0.05提示有統(tǒng)計(jì)學(xué)意義。研究結(jié)果:111篇文獻(xiàn)納入最終研究,經(jīng)由系統(tǒng)評(píng)價(jià)法,構(gòu)建了包涵"風(fēng)險(xiǎn)評(píng)估""分級(jí)預(yù)防" "教育指導(dǎo)"在內(nèi)的3個(gè)維度、52項(xiàng)骨科大手術(shù)深靜脈血栓護(hù)理預(yù)防策略,主要包含三級(jí)條目的證據(jù)等級(jí)、文獻(xiàn)質(zhì)量及參考附錄。隨后進(jìn)行2輪專家函詢,調(diào)整條目4項(xiàng)、刪除條目3項(xiàng),最后確立3維度49條目的骨科大手術(shù)患者深靜脈血栓的護(hù)理預(yù)防策略。2輪函詢的問(wèn)卷有效回收率依次為95%、100%,提出建議的專家比率依次為42.1%、26.3%,專家權(quán)威系數(shù)依次為0.85、0.87;第二輪CV波動(dòng)在0%-23.38%,協(xié)調(diào)系數(shù)W分別為0.280、0.407,顯著性檢驗(yàn)結(jié)果提示P0.000,表明該策略研究方法科學(xué),函詢結(jié)果協(xié)調(diào)、可靠,最終構(gòu)建的證據(jù)策略具有可操作性,便于臨床證據(jù)參考和應(yīng)用。研究結(jié)論:基于系統(tǒng)評(píng)價(jià)和Delphi法構(gòu)建的骨科大手術(shù)患者深靜脈血栓護(hù)理預(yù)防策略具有較高的科學(xué)實(shí)用性和可操作性,可為臨床護(hù)理及實(shí)踐操作提供客觀、可借鑒的實(shí)施策略,有利于有效深靜脈血栓預(yù)防措施的實(shí)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.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.6

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 魏鶴新;;骨科大手術(shù)后深靜脈血栓的預(yù)防[J];中國(guó)醫(yī)藥導(dǎo)報(bào);2008年22期

2 魏鶴新;;骨科大手術(shù)前后深靜脈血栓的預(yù)防[J];中國(guó)實(shí)用醫(yī)藥;2008年28期

3 于會(huì)群;李娟;魏薇;陳雪玲;;風(fēng)險(xiǎn)管理在預(yù)防骨科大手術(shù)病人壓瘡中的應(yīng)用研究[J];護(hù)理實(shí)踐與研究;2010年10期

4 凌明;;重慶某醫(yī)院骨科大手術(shù)術(shù)后抗凝藥物使用的調(diào)查與分析[J];檢驗(yàn)醫(yī)學(xué)與臨床;2012年10期

5 劉妮;尹桃;倪丹紅;葉倩倩;李秀杰;;某三甲醫(yī)院骨科大手術(shù)患者抗凝藥物使用分析[J];中國(guó)藥師;2013年03期

6 陳紅;;骨科大手術(shù)后早期健康訓(xùn)練的安全隱患與對(duì)策[J];右江民族醫(yī)學(xué)院學(xué)報(bào);2013年05期

7 朱紅;何富喬;王瑞珍;曾利輝;;從護(hù)理管理角度解讀《中國(guó)骨科大手術(shù)靜脈血栓預(yù)防指南》[J];中國(guó)護(hù)理管理;2011年04期

8 李清平;李世文;王忠岳;;骨科大手術(shù)后認(rèn)知功能障礙的臨床分析[J];浙江創(chuàng)傷外科;2007年06期

9 李虎;王健;史占軍;;骨科大手術(shù)應(yīng)用抗凝藥物的風(fēng)險(xiǎn)及并發(fā)癥[J];中華關(guān)節(jié)外科雜志(電子版);2013年01期

10 朱振安;;預(yù)防骨科大手術(shù)后靜脈血栓的新型抗凝藥物-磺達(dá)肝癸鈉[J];中華關(guān)節(jié)外科雜志(電子版);2009年01期

相關(guān)會(huì)議論文 前10條

1 楊寧;王倩;;骨科大手術(shù)后深靜脈栓塞形成的相關(guān)因素及預(yù)防效果分析[A];中華護(hù)理學(xué)會(huì)第14屆全國(guó)手術(shù)室護(hù)理學(xué)術(shù)交流會(huì)議論文匯編（上冊(cè)）[C];2010年

2 宮曉霞;;骨科大手術(shù)后深靜脈血栓的預(yù)防及護(hù)理[A];第二十二屆航天醫(yī)學(xué)年會(huì)暨第五屆航天護(hù)理年會(huì)論文匯編（下冊(cè)）[C];2006年

3 張明君;李建華;;骨科大手術(shù)后下肢深靜脈血栓的預(yù)防及護(hù)理[A];寧夏醫(yī)學(xué)會(huì)骨科學(xué)分會(huì)第三屆學(xué)術(shù)會(huì)議論文匯編[C];2005年

4 寧寧;;非藥物預(yù)防骨科大手術(shù)術(shù)后深靜脈血栓形成的最新研究進(jìn)展[A];全國(guó)第10屆骨科護(hù)理學(xué)術(shù)交流暨專題講座會(huì)議論文匯編[C];2008年

5 蔣恒;徐國(guó)紅;;低分子肝素聯(lián)合人力擠壓腓腸肌預(yù)防骨科大手術(shù)后下肢深靜脈血栓形成的研究[A];2008年浙江省骨科學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2008年

6 呂秋霞;;骨科大手術(shù)后DVT預(yù)防的護(hù)理干預(yù)[A];2013年河南省骨傷護(hù)理學(xué)術(shù)交流會(huì)論文集[C];2013年

7 賈曼;;骨科大手術(shù)后下肢深靜脈栓塞形成的綜合預(yù)防和護(hù)理[A];2009年浙江省骨科學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2009年

8 ;中國(guó)骨科大手術(shù)靜脈血栓栓塞癥預(yù)防指南[A];中國(guó)康復(fù)醫(yī)學(xué)會(huì)第七次全國(guó)老年醫(yī)學(xué)與康復(fù)學(xué)術(shù)大會(huì)資料匯編[C];2012年

9 朱紅;何富喬;王瑞珍;曾利輝;;從護(hù)理管理角度解讀《預(yù)防骨科大手術(shù)深靜脈血栓形成指南(草案)》[A];第六屆西部骨科論壇暨貴州省骨科年會(huì)論文匯編[C];2010年

10 龔海英;;多普勒超聲評(píng)價(jià)骨科大手術(shù)后下肢深靜脈血栓的價(jià)值[A];2007年浙江省超聲醫(yī)學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2007年

相關(guān)重要報(bào)紙文章 前7條

1 記者 王丹;骨科大手術(shù)后抗凝藥物至少用7天[N];健康報(bào);2008年

2 ;警惕骨科大手術(shù)后的致命威脅——血栓栓塞[N];中國(guó)醫(yī)藥報(bào);2014年

3 北京協(xié)和醫(yī)院骨科教授 邱貴興;骨科大手術(shù)易致血栓[N];大眾衛(wèi)生報(bào);2005年

4 記者 劉侃;為預(yù)防骨科大手術(shù)深靜脈血栓提供依據(jù)[N];科技日?qǐng)?bào);2005年

5 本報(bào)記者 朱國(guó)旺;骨科大手術(shù)需做好預(yù)防性抗凝[N];中國(guó)醫(yī)藥報(bào);2009年

6 新訊;利伐沙班可有效降低骨科術(shù)后血栓形成[N];醫(yī)藥經(jīng)濟(jì)報(bào);2009年

7 北京協(xié)和醫(yī)院骨科主任 邱貴興 教授;骨科手術(shù)為何易致血栓[N];健康報(bào);2005年

相關(guān)碩士學(xué)位論文 前6條

1 李林;VTE防控體系在預(yù)防骨科大手術(shù)圍手術(shù)期VTE中的作用[D];廣西醫(yī)科大學(xué);2017年

2 謝煜;基于系統(tǒng)評(píng)價(jià)與Delphi法構(gòu)建骨科大手術(shù)患者深靜脈血栓的護(hù)理預(yù)防策略研究[D];南京中醫(yī)藥大學(xué);2017年

3 徐飛;骨科大手術(shù)后載脂蛋白M與凝血指標(biāo)關(guān)系研究[D];中南大學(xué);2013年

4 肖紅衛(wèi);骨科大手術(shù)后下肢深靜脈血栓形成的預(yù)測(cè)和早期診斷[D];暨南大學(xué);2011年

5 孫洋;骨科大手術(shù)患者靜脈血栓栓塞癥發(fā)病率的小樣本前瞻性研究[D];吉林大學(xué);2013年

6 吳文仁;活血通絡(luò)法對(duì)骨科大手術(shù)患者血液流變學(xué)的影響[D];廣州中醫(yī)藥大學(xué);2013年

，

本文編號(hào)：1844379