本文選題：乳腺癌 + 淋巴水腫��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景乳腺癌居我國(guó)女性癌癥發(fā)病的第一位,且我國(guó)已成為世界上增長(zhǎng)速度最快的國(guó)家之一,而淋巴水腫是其嚴(yán)重的并發(fā)癥,通過(guò)相關(guān)預(yù)防行為的執(zhí)行可以有效降低乳腺癌術(shù)后淋巴水腫的發(fā)生率,目前國(guó)內(nèi)尚無(wú)以循證為基礎(chǔ)的乳腺癌術(shù)后淋巴水腫預(yù)防行為規(guī)范,為醫(yī)護(hù)人員及患者提供規(guī)范化指導(dǎo)。因此,應(yīng)結(jié)合現(xiàn)有最佳證據(jù)構(gòu)建具臨床指導(dǎo)意義的乳腺癌術(shù)后淋巴水腫預(yù)防行為臨床實(shí)踐指南。目的調(diào)查并分析醫(yī)護(hù)人員及乳腺癌術(shù)后患者對(duì)乳腺癌術(shù)后淋巴水腫預(yù)防行為認(rèn)知、執(zhí)行現(xiàn)狀、現(xiàn)存問(wèn)題,整合現(xiàn)有最佳證據(jù)、系統(tǒng)評(píng)價(jià)及相關(guān)指南等循證資源初步構(gòu)建基于循證的《乳腺癌術(shù)后淋巴水腫預(yù)防行為臨床實(shí)踐指南》。方法采用問(wèn)卷調(diào)查和半結(jié)構(gòu)式個(gè)人深入訪(fǎng)談結(jié)合的方式,深入了解并分析乳腺癌術(shù)后患者及醫(yī)護(hù)人員其乳腺癌術(shù)后淋巴水腫預(yù)防行為現(xiàn)狀及存在問(wèn)題,運(yùn)用Meta分析、系統(tǒng)評(píng)價(jià)和指南內(nèi)容分析整合現(xiàn)有最佳證據(jù),指南制定小組成員根據(jù)以上結(jié)果構(gòu)建乳腺癌術(shù)后淋巴水腫預(yù)防行為臨床實(shí)踐指南草案及指導(dǎo)手冊(cè)。結(jié)果1.在安徽省某四所三甲醫(yī)院乳腺外科、腫瘤科對(duì)272例乳腺癌術(shù)后患者進(jìn)行問(wèn)卷調(diào)查,對(duì)19例乳腺癌術(shù)后患者和16位醫(yī)護(hù)人員進(jìn)行半結(jié)構(gòu)式個(gè)人深入訪(fǎng)談發(fā)現(xiàn)當(dāng)前乳腺癌術(shù)后淋巴水腫預(yù)防行為缺乏具體的規(guī)范指導(dǎo)、患者的知曉率差、醫(yī)護(hù)人員的重視程度參差不齊和工作負(fù)荷較重等問(wèn)題。2.全面檢索數(shù)據(jù)庫(kù)并對(duì)符合納入標(biāo)準(zhǔn)的文獻(xiàn)質(zhì)量進(jìn)行嚴(yán)格評(píng)鑒,最終納入24篇隨機(jī)對(duì)照實(shí)驗(yàn)研究,文獻(xiàn)質(zhì)量處于中等及以上水平,對(duì)不同乳腺癌術(shù)后淋巴水腫預(yù)防行為進(jìn)行歸類(lèi)并進(jìn)行Meta分析,其中空氣波壓力治療儀、自制軟枕、艾灸療法及個(gè)性化功能鍛煉等預(yù)防行為可有效降低淋巴水腫的發(fā)生率。經(jīng)描述性分析口腔負(fù)壓吸引、患側(cè)上肢加壓和推拿療法等預(yù)防行為可以有效改善肢體腫脹程度及活動(dòng)度,為構(gòu)建指南提供證據(jù)支持。3.全面檢索各指南網(wǎng)站及數(shù)據(jù)庫(kù),最終共納入5項(xiàng)乳腺癌術(shù)后淋巴水腫預(yù)防行為相關(guān)臨床實(shí)踐指南其推薦意見(jiàn)和應(yīng)用說(shuō)明主要包括鍛煉、壓縮服裝的使用、感染的處理和皮膚護(hù)理等16項(xiàng),為構(gòu)建指南提供了證據(jù)支持。4.指南制定小組成員結(jié)合量性研究、質(zhì)性研究、系統(tǒng)評(píng)價(jià)和相關(guān)指南內(nèi)容分析研究結(jié)果構(gòu)建《乳腺癌術(shù)后淋巴水腫預(yù)防行為臨床實(shí)踐指南》草案及指導(dǎo)手冊(cè)。結(jié)論1.當(dāng)前乳腺癌術(shù)后淋巴水腫預(yù)防行為缺乏科學(xué)、規(guī)范和有效的指導(dǎo)。2.《乳腺癌術(shù)后淋巴水腫預(yù)防行為臨床實(shí)踐指南》共22條推薦建議,主要內(nèi)容為空氣波壓力治療儀、自制軟枕、艾灸療法、壓縮服裝的使用和感染(蜂窩織炎)的處理等,是基于循證的、以乳腺癌術(shù)后患者問(wèn)卷調(diào)查、醫(yī)護(hù)人員和乳腺癌術(shù)后患者半結(jié)構(gòu)式個(gè)人深入訪(fǎng)談、系統(tǒng)評(píng)價(jià)和指南內(nèi)容分析為依據(jù)構(gòu)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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R737.9

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