非创伤性下肢截肢患者生活体验质性研究的Meta整合

doi:10.3761/j.issn.0254-1769.2023.09.013

摘要/Abstract

摘要：

目的系统评价非创伤性下肢截肢患者生活的真实体验和感受。方法计算机检索PubMed、Cochrane Library、Embase、Web of Science、CINAHL、PsycINFO、中国知网、万方数据库、维普数据库、中国生物医学文献数据库关于非创伤性下肢截肢患者生活体验的质性研究，检索时限为建库至2022年8月。采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准进行文献质量评价，采用汇集性整合方法对结果进行归纳和整合。结果共纳入11项研究，提炼出43个结果，综合为3个整合结果。整合结果1：面临多重压力与挑战，打破生活常态。整合结果2：存在多维度未满足需求。整合结果3：采取不同的策略应对截肢事件。结论护理人员应识别和关注患者的负性心理，联合患者可获得的支持，减少患者未满足的需求，减轻向家庭过渡的压力，以促进患者重新融入并恢复正常社会生活。

关键词: 截肢者, 生活体验, 质性研究, Meta整合, 循证护理学

Abstract:

Objective To systematically review the real life experiences of nontraumatic lower extremity amputa-tions（NLEA） patients. Methods We searched databases，including PubMed，the Cochrane Library，Embase，Web of Science，CINAHL，PsycINFO，CNKI，Wan Fang data，VIP，and CBM from inception to August 2022 to collect qualitative studies on the real life experience of NLEA patients. The quality of included research was evaluated by the JBI Critical Appraisal Tool for qualitative studies from Australia. The results were summarized and integrated by the pooled integration methods. Results A total of 11 studies were included. 43 complete findings were grouped according to their similarities to form 3 integrated categories. The integration results were finally obtained. Integration results 1：facing multiple pressures and challenges，breaking the normalcy of life；integration results 2：there are multiple unmet needs；integration results 3：adopting different strategies to deal with amputation. Conclusion Nurses should pay attention to and understand the patient’s positive psychological state，and cooperate with available support to reduce the unmet needs of patients. It will be easier to reduce the transitional stress of the family，to help patients return to society better and improve their quality of life.

Key words: Amputees, Real Experience, Qualitative Research, Meta-Synthesis, Evidence-Based Nursing

张琦, 陈丽艳, 李媛媛, 张爱华, 杨丽娟. 非创伤性下肢截肢患者生活体验质性研究的Meta整合[J]. 中华护理杂志, 2023, 58(9): 1112-1119.

ZHANG Qi, CHEN Liyan, LI Yuanyuan, ZHANG Aihua, YANG Lijuan. The real life experience of nontraumatic lower extremity amputations patients：a qualitative Meta-synthesis[J]. Chinese Journal of Nursing, 2023, 58(9): 1112-1119.

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参考文献 36

[1]	Bernatchez J, Mayo A, Kayssi A. The epidemiology of lower extremity amputations,strategies for amputation prevention,and the importance of patient-centered care[J]. Semin Vasc Surg, 2021, 34(1):54-58. DOI PMID
[2]	Meshkin DH, Zolper EG, Chang K, et al. Long-term mortality after nontraumatic major lower extremity amputation:a systematic review and Meta-analysis[J]. J Foot Ankle Surg, 2021, 60(3):567-576. DOI PMID
[3]	Creager MA, Matsushita K, Arya S, et al. Reducing nontraumatic lower-extremity amputations by 20% by 2030:time to get to our feet:a policy statement from the American Heart Association[J]. Circulation, 2021, 143(17):e875-e891.
[4]	Barg FK, Cronholm PF, Easley EE, et al. A qualitative study of the experience of lower extremity wounds and amputations among people with diabetes in Philadelphia[J]. Wound Rep Reg, 2017, 25(5):864-870. DOI URL
[5]	Kayssi A, De Mestral C, Forbes TL, et al. Predictors of hospital readmissions after lower extremity amputations in Canada[J]. J Vasc Surg, 2016, 63(3):688-695. DOI PMID
[6]	Zolper EG, Deldar R, Haffner ZK, et al. Effect of function-based approach to nontraumatic major lower extremity amputation on 5-year mortality[J]. J Am Coll Surg, 2022, 235(3):438-446. DOI URL
[7]	Zhou X, Andes LJ, Rolka DB, et al. Trends in nontraumatic lower-extremity amputation among privately insured adults with diabetes in the US,2004-2018[J]. Diabetes Care, 2021, 44(5):e93-e94. DOI URL
[8]	Xu Z, Ran X. Diabetic foot care in China:challenges and stra-tegy[J]. Lancet Diabetes Endocrinol, 2016, 4(4):297-298. DOI URL
[9]	Silva JC, Oliveira VC, Lima P, et al. Change in domains that influence quality of life after major lower limb amputation in patients with peripheral arterial disease[J]. Ann Vasc Surg, 2021, 75:179-188. DOI PMID
[10]	孙闽闽, 吴娟, 李文霞, 等. 心肌梗死患者出院后重返社会体验质性研究的Meta整合[J]. 中华护理杂志, 2022, 57(4):415-423. DOI
	Sun MM, Wu J, Li WX, et al. The experiences of patients with myocardial infarction returning to society after being discharged from the hospital:a Meta-synthesis of qualitative studies[J]. Chin J Nurs, 2022, 57(4):415-423.
[11]	胡雁. 如何开展质性研究的系统评价和Meta整合[J]. 上海护理, 2020, 20(7):1-5.
	Hu Y. How to carry out systematic review and Meta-synthesis of qualitative studies[J]. Shanghai Nurs, 2020, 20(7):1-5.
[12]	Zhu X, Goh LJ, Chew E, et al. Struggling for normality:experiences of patients with diabetic lower extremity amputations and post-amputation wounds in primary care[J]. Prim Health Care Res Dev, 2020, 21(e63):1-10.
[13]	Washington ED, Williams AE. An exploratory phenomenological study exploring the experiences of people with systemic disease who have undergone lower limb amputation and its impact on their psychological well-being[J]. Prosthet Orthot Int, 2016, 40(1):44-50. DOI PMID
[14]	Torbjörnsson E, Ottosson C, Blomgren L, et al. The patient’s experience of amputation due to peripheral arterial disease[J]. J Vasc Nurs, 2017, 35(2):57-63. DOI PMID
[15]	Radenovic M, Aguilar K, Wyrough AB, et al. Understanding tran-sitions in care for people with major lower limb amputations from inpatient rehabilitation to home:a descriptive qualitative study[J]. Disabil Rehabil, 2021, 44(16):4211-4219. DOI URL
[16]	Mackay C, Cimino SR, Guilcher SJT, et al. A qualitative study exploring individuals’ experiences living with dysvascular lower limb amputation[J]. Disabil Rehabil, 2022, 44(10):1812-1820. DOI URL
[17]	Livingstone W, Mortel TF, Taylor B. A path of perpetual resilience:exploring the experience of a diabetes-related amputation through grounded theory[J]. Contemp Nurse, 2011, 39(1):20-30. DOI PMID
[18]	Leonard C, Sayre G, Williams S, et al. Understanding the experience of veterans who require lower limb amputation in the veterans health administration[J]. PloS One, 2022, 17(3):e0265620. DOI URL
[19]	Küçük Öztürk G, Yüceler Kaçmaz H, Öztürk Rİ. Narrative experiences of individuals with lower limb amputation:a qualitative study[J]. Int J Low Extrem Wounds, 2022:1534734622-1087497.
[20]	Gómez-Ibáñez R, Bernabeu-Tamayo MD, Aguayo-González M, et al. Early patient experiences of primary above-the-knee amputation from vascular etiologies:a phenomenological study[J]. Clin Nurs Res, 2021, 30(5):539-547. DOI PMID
[21]	Canbolat Seyman C, Uzar Ozcetin YS. “I wish I could have my leg”:a qualitative study on the experiences of individuals with lower limb amputation[J]. Clin Nurs Res, 2022, 31(3):509-518. DOI URL
[22]	Amoah VMK, Anokye R, Acheampong E, et al. The experiences of people with diabetes-related lower limb amputation at the Komfo Anokye Teaching Hospital(KATH) in Ghana[J]. BMC Res Notes, 2018, 11(1):1-5. DOI URL
[23]	Crocker RM, Palmer KNB, Marrero DG, et al. Patient perspectives on the physical,psycho-social,and financial impacts of diabetic foot ulceration and amputation[J]. J Diabetes Compli-cations, 2021, 35(8):107960.
[24]	Escribano X. Corporalidad, discapacidad,creatividad:aprendiendo de nuevo a ver el mundo[C]. Discursos en torno a la dis-capacidad:paradigmas,espacios e itinerarios, 2017:155-176.
[25]	姚芡芡, 蒲树英, 白阳娟, 等. 头颈癌患者身体意象体验质性研究的系统评价[J]. 中华护理杂志, 2021, 56(12):1860-1867. DOI
	Yao QQ, Pu SY, Bai YJ, et al. A Meta-synthesis of body image experience in patients with head and neck cancer[J]. Chin J Nurs, 2021, 56(12):1860-1867. DOI
[26]	梅伶俐, 陈朔晖, 胡艳, 等. 社会生态系统理论视角下短肠综合征患儿照护者负担体验的质性研究[J]. 中华护理杂志, 2022, 57(6):718-723. DOI
	Mei LL, Chen SH, Hu Y, et al. Caring experience of caregi-vers of children with short bowel syndrome based on the social ecological theory:a qualitative study[J]. Chin J Nurs, 2022, 57(6):718-723.
[27]	Nieuwstraten JA, Van Doorn LP, Gebhardt WA, et al. Stakeholder values and preferences in lower limb amputation for no-option chronic limb threatening ischemia[J]. Patient Prefer Adherence, 2021, 2021(15):1051-1059.
[28]	孙鑫章, 胡艳红, 龚爱萍, 等. 护士参与共享决策的角色功能及阻碍因素研究进展[J]. 中国护理管理, 2022, 22(5):688-692.
	Sun XZ, Hu YH, Gong AP, et al. Exploring the role and obstructive factors of nurses in shared decision making[J]. Chin Nurs Manag, 2022, 22(5):688-692.
[29]	Keszler MS, Wright KS, Miranda A, et al. Multidisciplinary amputation team management of individuals with limb loss[J]. Curr Phys Med Rehabil Rep, 2020, 8(3):118-126. DOI
[30]	世界卫生大会. 世卫组织2014—2021年全球残疾问题行动计划草案:增进所有残疾人的健康[EB/OL].(2014-04-14)[2022-09-22]. https://apps.who.int/iris/handle/10665/162909.
	World Health Assembly. The WHO 2014-2021 annual global action plan on disability:promotes the health of all persons with disabilities[EB/OL].(2014-04-14)[2022-09-22]. https://apps.who.int/iris/handle/10665/162909.
[31]	Dunne S, Coffey L, Gallagher P, et al. “If I can do it I will do it,if I can’t,I can’t”:a study of adaptive self-regulatory strategies following lower limb amputation[J]. Disabil Rehabil, 2014, 36(23):1990-1997. DOI URL
[32]	廖文娜, 罗向晗, 叶增杰. 新型冠状病毒肺炎疫情下大学生社会支持与创伤后应激症状的关系:控制感与回避型应对策略的链式多重中介作用[J]. 中国健康心理学杂志, 2022, 30(6):914-920.
	Liao WN, Luo XH, Ye ZJ, et al. Relationship between college students social support and post-traumatic stress symptoms in a pandemic:chained multiple mediating effects of sense of control and avoidance coping strategies[J]. China J Health Psy-chol, 2022, 30(6):914-920.
[33]	Roth S, Cohen LJ. Approach,avoidance,and coping with stress[J]. Am Psychol, 1986, 41(7):813. DOI PMID
[34]	Weiss NH, Risi MM, Sullivan TP, et al. Post-traumatic stress disorder symptom severity attenuates bi-directional associations between negative affect and avoidant coping:a daily diary study[J]. J Affect Disord, 2019, 259:73-81. DOI URL
[35]	Forbes MA. Hope in the older adult with chronic illness:a comparison of tow research methods in theory building[J]. ANS Adv Nurs Sci, 1999, 22(2):74-87. DOI URL
[36]	刘颖, 陈佳丽, 宁宁, 等. 骨肿瘤手术患者创伤后成长的调查研究[J]. 中华护理杂志, 2022, 57(10):1184-1190. DOI
	Liu Y, Chen JL, Ning N, et al. Study on the relationship between post-traumatic stress and post-traumatic growth in patients with bone neoplasms surgery[J]. Chin J Nurs, 2022, 57(10):1184-1190. DOI