| Purpose:1.Evaluate the effect and risk of breast massage combined with point massage on the lactation of pregnant women,and provide clinical decision basis for clinical decision.2.Sum up the related evidence of breast massage and point massage to improve breast secretion.3.Construct an evidence-based breast massage combined with acupoint massage to promote milk secretion.Method:1.Breast massage combined with acupoint massage promotes the generation of evidence related to milk secretion.(1)A systematic review and meta-analysis of the effects and risks of breast massage combined with meso-point massage in nursing intervention.To search for clinical research on breast massage combined with acupoint massage to intervene parturient’s lactation worldwide,and to analyze the research results that meet the standards of lactation,so as to evaluate the benefits and risks of breast massage combined with acupoint massage to intervene parturient’s lactation.(2)Analysis of the regularity of breast massage combined with acupoint massage in intervening puerpera’s acupoint use.Research on breast massage in combination with point massage was carried out in the world,and the literature was classified by the frequency,the frequency of intervention,the time of intervention and the days of intervention.Statistical analysis was carried out on the data collected by frequency,so as to know the features of acupuncture point usage and intervention.(3)Evidence summary and evaluation of acupoints related to promoting milk secretion in ancient books.The evidence of ancient books was searched in the database of the Chinese medical code,and the research team determined the evidence to be included according to the admission standard,and evaluated the final evidence of ancient books according to the Scale for Evaluation and Classification of Evidence for Prevention and Treatment of Ancient Books in Traditional Chinese Medicine.2.Construct an evidence-based breast massage combined with acupoint massage to promote milk secretion intervention program.(1)Qualitative interview was used to find out the gap between clinical practice and evidence.(2)Through the expert conference,the experts were invited to evaluate the evidence from four aspects: feasibility,suitability,clinical meaning and efficacy,and finally to decide the appropriate evidence for intervention.Results:1.Breast massage combined with acupoint massage promotes the generation of evidence related to milk secretion.(1)A systematic review and meta-analysis of the effects and risks of breast massage combined with meso-point massage in nursing intervention.In the end,24 articles were included,of which 4513 women were delivered.The results indicate that there is a high risk of bias and poor overall quality.Based on the frequency of massage and the number of massage points,it is found that there are significant differences among the different outcome indicators.The sensitivity analysis indicated that the results were not significantly different,which showed the stability of the study.However,the evaluation of publication bias indicates that there is a higher risk of publication bias.In this study,24 randomized controlled studies(RCT)were included,and 4513 women were randomized.In all of the studies,the combination of breast massage and point massage was compared with routine nursing care.Of these,22 were meta-meta-analyses,and the other 2 were not reported on the target outcome.None of the included studies reported an exclusive breastfeeding rate for 6 months,the primary outcome of this systematic review.The results of meta-analysis indicated that the rate of adverse events(breast pain)in the treatment group was significantly lower than in the routine care group(RR = 0 21,95% CI [0.13,0.32];Z = 6.92;P < 0.0001;I ~2 = 69%),the time of lactation was shortened(MD =-15.72,95% CI [-26.84,-4.60];Z = 2.77,P < 0.0001;I ~2 = 100%),and the serum prolactin level increased(MD =52.51,95% CI [44.68,60.35];Z = 13.14;P < 0.0001;I ~2 = 94%).(2)Analysis of the regularity of breast massage combined with acupoint massage in intervening puerpera’s acupoint use.Finally,131 articles were included,including 93 articles concerning the intervention measure of acupoint massage combined with breast massage,38 articles concerning the intervention measure of acupoint massage,a total of 55 acupoints,with a total frequency of 799.The frequencies are respectively as follows: Rugen(121),Tanzhong(117),Shaoze(79),Hegu(57),Ruzhong(56),Zhongfu(55),Tianchi(37),Yingchuang(29),Shenfeng(26),Zusanli(24),Quchi(16),Taichong(15),Wuyi(14),Jianjing(13),Zhourong(11),Atrium(11),Tianxi(11),Sanyijniao(11),Zhongwan(7),Yunmen(5),Xuehai(5)Xixiang(5)Yuanye(4)4)Neiguan(4)Lingxu(4)Geshu(4)Yongquan(3)Weishu(3)Ganshu(3)Shidou(3)Houxi(3)Yinshi(1)Futu(1)Jiexi(1)Warehouse(1)Quepen(1)Tian Shu(1)Liang Qiu(1)Shenque(1)Qihai(1)Dadun(1)Baobao(1)Taixi(1)Bulang(1)Zhongfeng(1)Xinshu(1)Feishu(1)Dachangshu(1).The first three categories with higher intervention frequency were twice a day,once a day,and three times a day,respectively.The first three intervention days and the most frequent categories were 3 days,2 days and 4 days,respectively.The meridian frequencies of the acupoints were successively as follows: stomach meridian of foot yangming(252),conception vessel(140),small intestine meridian of hand taiyang(82),large intestine meridian of hand yangming(73),lung meridian of hand taiyin(60),spleen meridian of foot taiyin(47),pericardium meridian of hand jueyin(41),kidney meridian of foot shaoyin(35),liver meridian of foot jueyin(30),bladder meridian of foot taiyang(19),sanjiao meridian of hand shaoyang(13)and gallbladder meridian of foot shaoyang(4).(3)Evidence summary and evaluation of acupoints related to promoting milk secretion in ancient books.A total of 536 entries were initially retrieved in the ancient books database of Chinese Medical Dictionary(72 in Tanzhong,71 in Ruzhong,46 in Rugen,18 in Tianchi,6 in Yuanye,31 in Yingchuang,27 in Uyi,8 in Shenfeng,13 in Yunmen,30 in Zhongfu,30 in Quchi,65 in Hegu,48 in Shaoze,25 in Qiangu,24 in Liang Qiu,17 in Zusanli and 5 in Zulinqi).According to the inclusion and exclusion criteria,30 pieces of evidence were finally included after panel discussion.According to the Classification Scale for Evidence Evaluation of Prevention and Treatment of Ancient Books of Traditional Chinese Medicine,there were seven pieces of evidence as low-level evidence and 23 pieces of evidence as intermediate evidence.Finally,the results of meta-analysis,descriptive research and 30 pieces of ancient books were summarized and put into the expert meeting questionnaire as a supplement to the supporting evidence of breast massage combined with acupoint massage in the expert meeting questionnaire.2.Construct an evidence-based breast massage combined with acupoint massage to promote milk secretion intervention program.(1)This study conducted qualitative interviews with 19 employees,and summarized the similar codes.Among the obstacles,three themes were identified: some employees’ actual operation was inconsistent with the evidence,they did not follow the unified training,employees lacked knowledge,it was difficult to understand the evidence content,and some evidence did not fully consider the practical application situation;Among the promoting factors,three themes are identified: the existing clinical practice of practitioners is the basis for promoting the implementation of evidence,the benefits brought by promoting the implementation of evidence for work,improving the enthusiasm of practitioners to learn evidence,and the practitioners have a positive attitude towards the content of evidence and are willing to apply evidence to practical work.Taking these factors into account,we should adjust the content of the scheme and narrow the gap between clinical practice and evidence application.(2)Based on the interview results,an expert meeting was held,and finally an intervention program of breast massage combined with acupoint massage to promote milk secretion was formed.The program was divided into two aspects: lactation evaluation and breast massage combined with acupoint massage.Conclusion:1.By sorting out and analyzing the characteristics of selecting and using acupoints in modern literature and ancient books,according to the number of acupoints used in the literature,the frequency of acupoints,the frequency of intervention and the number of days of intervention,the relevant evidence that breast massage combined with acupoint massage promotes milk secretion is summarized.2.In this study,an evidence-based intervention scheme of breast massage combined with acupoint massage to promote milk secretion was constructed,which was divided into two aspects: lactation evaluation and operation process of breast massage combined with acupoint massage technology. |
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