心脏疾病患者植入型心律转复除颤器初始植入决策质性研究的Meta整合  

Qualitative studies and Meta-integration on decision-making for initial implantation of implantable cardioverter defibrillator in patients with heart disease

作　　者：卢静 孙国珍[1,2] 刘沈馨雨 于甜栖 Lu Jing;Sun Guozhen;Liu Shenxinyu;Yu Tianqi(School of Nursing,Nanjing Medical University,Nanjing 211166,China;不详)

机构地区：[1]南京医科大学护理学院,南京211166 [2]南京医科大学第一附属医院心血管内科,南京210029

出　　处：《中国循证心血管医学杂志》2024年第6期661-666,689,共7页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家自然科学基金(72074124);江苏高校优势学科建设工程项目(JX10631804)。

摘　　要：目的系统评价心脏疾病患者植入型心律转复除颤器(ICD)初始植入决策的质性研究。方法检索PubMed、The Cochrane Library、EMbase、Web of Science、CINAHL、Scopus、PsycINFO、中国知网、万方数据库,搜集心脏疾病患者ICD初始植入决策质性研究文献,检索时限均为建库至2023年6月,采用澳大利亚循证卫生保健中心质性研究质量评价标准进行评价,运用Meta整合方法对结果进行归纳整理。结果共纳入14篇文献,提炼出32个完整的研究主题,归纳形成8个类别,整合得出3个结果:以患者为中心的决策困境;支持与阻碍并存的情境因素;风险收益权衡后的决策结果。结论心脏疾病患者ICD初始植入决策中存在诸多心理和现实困境,医务人员应关注患者决策状态和情绪;尊重并帮助患者澄清个体差异化的决策偏好和价值观;及时、动态评估决策冲突,探索高质量多元辅助支持策略,减少决策后悔,提高决策水平。Objective To review systematically the qualitative studies on decision-making for initial implantation of implantable cardioverter defibrillator(ICD)in patients with heart disease.Methods The databases of PubMed,The Cochrane Library,EMbase,Web of Science,CINAHL,Scopus,PsycINFO,CNKI and WanFang were retrieved to collecting the literature of qualitative studies on decision-making for ICD initial implantation from patients with heart disease.The retrieving period was from database establishment time to June 2023.The quality of collected literatures was reviewed according to quality assessment criteria for qualitative studies of Australian Joanna Briggs Institute(JBI).The results were summed up and sorted out by using Meta synthesis method.Results There were totally 14 literatures obtained included,and 32 complete study themes,8 categories and 3 results extracted,summed up and integrated,which were patient-centered decision-making dilemmas,contextual factors with support and hinder coexistence and decision results after trade-off of risk and benefit.Conclusion There are many practical and psychological challenges in the initial decision-making process of ICD implantation in patients with heart disease.Medical practitioners should pay attention to the decision-making state and emotion of patients,respect and help patients clarify individual differentiated decision-making preferences and values,timely and dynamically assess decision-making conflicts,explore superb multiple auxiliary support and reduce decision regret to improve the quality of ICD decision-making.

关 键 词：植入型心律转复除颤器 心脏疾病 质性研究 Meta整合 

分 类 号：R54[医药卫生—心血管疾病]