癌症放化疗患者口腔黏膜炎护理循证实践方案的构建  

Evidence-based interventions for the management of oral mucositis among cancer patients

作　　者：顾艳荭[1,2] 胡雁[1] 桑燕[3] 徐旭娟[2] 朱健华[4] 王静[1] 

机构地区：[1]复旦大学护理学院,上海200032 [2]南通大学附属医院护理部,226001 [3]南通大学附属医院信息科,226001 [4]南通大学附属医院心内科,226001

出　　处：《中华现代护理杂志》2014年第29期3665-3672,共8页Chinese Journal of Modern Nursing

基　　金：江苏省第九批“六大人才高峰”资助项目（WS-062）;复旦大学院级课题资助项目（FNSF201101）

摘　　要：目的结合我国临床情景，找出癌症放化疗患者口腔黏膜炎防治的最佳证据，构建口腔黏膜炎护理循证实践方案。方法以“知识-行动程序”（KTA）为理论框架，采用结构化文献检索和检索循证资源数据库进行证据查询。通过文献质量评价，结合国内临床情境和文献计量与内容分析，依据JBI“最佳实践信息手册作者指南”、“2010年版证据推荐级别和证据分级方法”进行证据综合、提炼和净化，初步构建循证实践方案；采用专家现场论证和焦点组访谈方法，对方案初稿进行可用性评鉴和调整，最终确立循证实践方案。结果经文献质量评价，共纳入临床循证实践指南3篇，系统评价14篇，随机对照试验1篇，多中心现况调查报告1篇，专家共识或专家意见综述共3篇，JBI证据总结1篇；综合证据文献形成最佳信息实践手册4篇，证据总结1篇。构建口腔黏膜炎护理循证实践方案内容包括：癌症放化疗患者标准化VI腔评估流程、癌症放化疗患者口腔黏膜炎护理流程、口腔黏膜炎健康教育手册、癌症放化疗患者口腔护理操作标准和护理质量审查标准。结论本方案构建过程科学、严谨、可靠，为循证证据转化和应用提供了参考和依据；方案内容循证依据充分、具有可操作性和安全性、经济成本可接受、适用于国内临床护理情境，对癌症患者口腔黏膜炎护理实践与质量管理具有指导作用。Objective To establish a high-quality and evidence-based interventions for management of oral mucositis on cancer patients who received chemo-radio therapy in Chinese clinical status. Methods Under the guidance of knowledge-to-action （KTA） process framework, we retrieved all evidence in evidence-based health care databases by the method of a structured search of the literature. Through reviewed and analysed the quality of literature and analysed national health environment, we synthesized, distilled and refined the evidence into best practice interventions according to JBI Best Practice Information Sheet author guideline and JBI- developed 2010 Grades of Effectiveness and levels of evidence. All interventions evaluated by relative experts and focus-group-discussion. Results After assessed the quality of literature, there were three articles that had been collected by the guideline of evidence based clinical practice, fourteen by systematically assessment, one by investigation report of current multicentric status, added three expert＇ s literature review or opinion, one evidence literature review. That all collected information had been formed four best information practice manual and one evidence-based summary. To establish the evidence-based nursing interventions for oral mucositis should include oral assessment process, oral care process, the pamphlet of patient education, basic oral care technique and quality audit standards. Conclusions Through the process of interventions＇ establishment, scientific credible and rigorous attitudes guided. Interventions supported by abundant evidence to ensure that they were practical, economical and suitable to manage and guide oral mucositis among cancer patients in Chinese clinical.

关 键 词：肿瘤 口腔黏膜炎 循证实践 放射疗法 化学疗法 方案构建 

分 类 号：R473.73[医药卫生—护理学]