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系統識別號 U0026-0609201009304800
論文名稱(中文) 慢性腎臟病多專業照護介入成效之統合分析
論文名稱(英文) Effects of Multidisciplinary Care in Chronic Kidney Disease: A Systematic Review and Meta-analysis
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 98
學期 2
出版年 99
研究生(中文) 楊文中
研究生(英文) Wen-Chung Yang
學號 t2697104
學位類別 碩士
語文別 中文
論文頁數 75頁
口試委員 指導教授-顏妙芬
口試委員-宋俊明
口試委員-李鳳屏
中文關鍵字 慢性腎臟病  多專業照護  住院天數  死亡率  腎功能  統合分析 
英文關鍵字 chronic kidney disease  multidisciplinary care  hospital days  mortality  renal function  meta-analysis 
學科別分類
中文摘要 目的:
多專業照護(multidisciplinary care, MDC)介入成效在許多慢性腎臟病研究中仍有不一致的結果,本研究目的為探討多專業照護對慢性腎臟病患者住院天數、死亡率與腎功能的成效。
方法:
本研究運用系統性文獻回顧與統合分析法,搜尋1993年1月至2009年12月發表之中英文文獻,以電子資料庫查詢台灣期刊論文索引系統、台灣博碩士論文知識加值系統、中文電子期刊服務、中文電子學位論文服務、Cumulative index to Nursing and Allied Health Literature(CINAHL)、The Cochrane Library、Medline、PubMed and ProQuest Dissertations and Themes共9種國內外資料庫,使用關鍵字為慢性腎臟病、慢性腎功能不全、慢性腎衰竭、多專業照護、透析前照護、透析前教育、住院天數、死亡率與腎功能。並逐一檢視所有選取文獻與相關文獻的參考書目。研究選取的標準為:(1)18歲以上成人,並被診斷為慢性腎臟病患者,且於進行腎臟替代療法(renal replacement therapy, RRT)前接受多專業照護者;(2)多專業照護係指由腎臟專科醫師、護理人員、營養師與社工人員共同組成,且於研究中有詳述流程;(3)研究中有包含任一項成果指標之探討。本研究選取高品質評價之文章進行分析,資料登錄內容包含研究特徵、樣本特徵、方法與介入特徵和統計相關資料,並使用comprehensive meta-analysis(CMA)第二版統計軟體,並以Chochrane Q與I2計算研究間的異質性分析,若所選取研究為同質性,則結果將採固定模式(fix model)解釋。
結果:
符合本研究之文章共有7篇(1330位病患),結果顯示介入多專業照護比起未介入組能減少住院天數(ES:- 0.60;95% CI為0.02, - 0.86;Z = - 4 .56;p = 0.00)與降低71%的死亡率(OR:0.29;95% CI為0.18, 0.45;Z = - 5.37;p = 0.00),在慢性腎臟病患者首次透析時的腎功能差異上,呈現介入組較控制組為低(ES:- 0.28;95% CI為- 0.55, - 0.02;Z = - 2.08;p = 0.04)。
結論:
應用多專業照護介入慢性腎臟病患可減少住院天數並降低死亡率。因此,多專業照護應成為慢性腎臟病防制策略中重要的一環。
英文摘要 Purpose:
Multidisciplinary care (MDC) in chronic kidney disease (CKD) has been evaluated in various studies, but its effectiveness has inconsistent results. The purpose of this study was to determine the effect of MDC on hospital days, all cause mortality and renal function among patients with CKD.
Method:
This research was a systematic review study with meta-analysis technique. Literature was retrieved from 1993 through 2009. Databases included PerioPath (Index to Taiwan Periodical Literature System), National Digital Library of Theses and Dissertations in Taiwan (NDLTD), Chinese Electronic Periodical Services (CEPS), Chinese Electronic Theses & Dissertations Service (CETD), Cumulative index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, Medline, PubMed, and ProQuest Dissertations and Themes. Keywords included chronic kidney disease, chronic renal insufficiency, chronic renal failure, multidisciplinary care, pre-dialysis care, pre-dialysis education, hospital days, mortality, and renal function. All reference lists, including studies and related articles, were checked after selection based on title and abstract.
Studies were included if they contained (1) adult patients over 18 years old who diagnosed as chronic kidney disease and attended MDC before renal replacement therapy (RRT); and (2) MDC was consisted by nephrologist, nurse, dietician, and social worker, and MDC protocol was described clearly in studies; and (3) study included one of the interest measures.
RCT or non-RCT studies with a high quality rating were included. Data on characteristics of the study, subjects, intervention and statistic results were extracted using standardized form. All data were calculated by comprehensive meta-analysis software. The Chochrane Q and I2 were used to examine heterogeneity between studies. The outcome results were combined using fix model if they were homogeneity.
Results:
Seven studies fulfilled inclusion criteria. There was significant effect in reduce hospital days (ES: - 0.60; 95% CI, 0.02 to - 0.86; Z = - 4.56, p = 0.00) and 71% mortality rate (OR:0.29;95% CI, 0.18 to 0.45; Z = -5.37; p = 0.00) in intervention group. There was significant lower renal function in the intervention group as compared with the usual care (ES:- 0.28; 95% CI, -0.55 to -0.02; Z = -2.08; p = 0.04), although heterogeneity was found (p = 0.04).
Conclusion:
MDC was significantly reduced hospital days and mortality rate in patients with CKD. The effective care model should be used to implantation in clinical settings.
論文目次 中文摘要 I
英文摘要 III
致謝 V
圖目錄 IX
表目錄 IX
附件目錄 IX
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 5
第三節 研究問題 5
第二章 文獻查證 6
第一節 統合分析 6
第二節 慢性腎臟病多專業照護 11
第三節 國內外相關實證研究 14
第四節 慢性腎臟病多專業照護成效影響因素 16
第三章 研究設計與方法 18
第一節 名詞解釋 18
第二節 研究過程 21
第三節 研究工具 25
第四節 資料分析 26
第四章 研究結果 27
第一節 樣本特性 27
第二節 多專業照護團隊特性 30
第三節 研究品質評價分析 34
第四節 住院天數整體效果量分析 37
第五節 死亡率整體效果量分析 39
第六節 腎功能整體效果量分析 41
第五章 討論 43
第一節 樣本特性討論 43
第二節 多專業團隊討論 45
第三節 住院天數效果量討論 47
第四節 死亡率效果量討論 49
第五節 腎功能效果量討論 50
第六章 結論、限制與建議 52
第一節 結論 52
第二節 研究結果應用與建議 53
第三節 研究限制 55
參考文獻 56
中文部分 56
英文部分 57

圖目錄
圖3-1-1 住院天數與死亡率測量時間 19
圖3-2-1 文獻選取流程 24

表目錄
表3-1-1 慢性腎臟病分期 18
表4-1-1 研究描述 28
表4-2-1 多專業照護團隊特性 32
表4-3-1 研究品質評分表 36
表4-4-1 住院天數4篇統合分析結果 37
表4-4-2 住院天數3篇高品質研究統合分析結果 38
表4-4-3 住院天數Forest Plot 38
表4-5-1 死亡率4篇統合分析結果 39
表4-5-2 死亡率3篇高品質研究統合分析結果 40
表4-5-3 死亡率Forest Plot 40
表4-6-1 腎功能4篇統合分析結果 41
表4-6-2 腎功能3篇高品質研究統合分析結果 42
表4-6-3 腎功能Forest Plot 42

附件目錄
附錄一 編碼簿 68
附錄二 隨機控制試驗研究品質評價表 72
附錄三 非隨機控制試驗研究品質評價表 73


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