癌症放化疗患者口腔黏膜炎护理循证实践方案的构建

摘要

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 .%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口腔评估流程、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。