肌内效贴联合徒手引流预防乳腺癌术后淋巴水肿价值探讨

Value of intramuscular effect patch combined with freehand technique drainage in the prevention of lymphedema after breast cancer surgery

目的探讨肌内效贴联合徒手引流预防乳腺癌术后淋巴水肿的效果。方法选择2019-05-01-2022-10-31山东省肿瘤防治研究院收治的88例乳腺癌术后患者作为研究对象,根据组间基本资料均衡可比的原则分为对照组(44例)和观察组(44例)。对照组施行常规康复训练+徒手引流,观察组在对照组护理基础上施行肌内效贴。对比2组上肢功能评定量表(DASH)评分、淋巴水肿发生率、上肢淋巴流量、双侧上臂周径差值、肩关节活动度及生活质量评分。结果肌内效贴实施后,观察组DASH评分为(12.45±2.25)分,低于对照组的(18.36±3.15)分,t=10.127,P<0.001;观察组双侧上臂周径差值为(2.84±0.28)cm,低于对照组的(3.72±0.48)cm,t=10.504,P<0.001;观察组上肢淋巴流量为(15.68±2.69)count/s,多于对照组的(10.52±1.10)count/s,t=11.777,P<0.001。观察组淋巴水肿发生率为11.36%,低于对照组的36.36%,χ^(2)=7.568,P=0.006。肩关节活动度比较,观察组前驱(142.24±4.78)°,高于对照组的(125.36±4.58)°,t=7.043,P<0.001;观察组后伸(49.58±5.85)°,高于对照组的(40.32±5.10)°,t=3.833,P<0.001;观察组外展(153.74±15.19)°,高于对照组的(136.42±15.27)°,t=9.210,P<0.001;观察组内收(37.14±4.25)°,高于对照组的(31.22±4.30)°,t=9.210,P<0.001。生活质量评分比较,观察组躯体评分为(95.25±1.20)分,高于对照组的(79.25±1.58)分,t=53.492,P<0.001;认知评分为(94.56±1.45)分,高于对照组的(79.25±1.52)分,t=48.344,P<0.001;社会功能评分为(95.25±1.45)分,高于对照组的(78.25±1.14)分,t=53.129,P<0.001;角色评分为(95.25±1.45)分,高于对照组的(78.25±1.14)分,t=53.129,P<0.001;情绪功能评分为(93.25±2.45)分,高于对照组的(73.25±1.99)分,t=48.826,P<0.001。结论对乳腺癌术后患者施行肌内效贴联合徒手引流有助于缩小双侧上臂周径差值,预防淋巴水肿,改善患者术后上肢功能和肩关节活动度,提高生活质量。

Objective To investigate the effect of intramuscular effect patch combined with freehand technique drainage on the prevention of lymphedema after breast cancer surgery.Methods From May 1,2019to October 31,2022,88postoperative patients with breast cancer admitted by Shandong Cancer Hospital and Institute were selected as research objects.According to the principle of balanced and comparable basic data between groups,they were divided into control group(44cases)and observation group(44cases).The control group received routine rehabilitation training combined with freehand technique drainage,and the observation group received intramuscular effect patch on the basis of the control group’s nursing.The scores of disability of shoulder and hand(DASH),incidence of lymphedema,upper limb lymphatic flow,bilateral upper arm circumference difference,shoulder joint activity and quality of life were compared between the two groups.Results After the implementation of intramuscular effect patch,the DASH score of the observation group was12.45±2.25,which was lower than that of the control group(18.36±3.15),t=10.127,P<0.001.The difference of bilateral upper arm circumference in the observation group was(2.84±0.28)cm,which was lower than that in the control group(3.72±0.48)cm,t=10.504,P<0.001.The lymph flow of the upper extremity in the observation group was(15.68±2.69)count/s,which was higher than that in the control group(10.52±1.10)count/s,t=11.777,P<0.001.The incidence of lymphedema in the observation group was 11.36%,which was lower than 36.36%in the control group(χ^(2)=7.568,P=0.006).The range of motion of shoulder joint in the observation group was(142.24±4.78)°,which was higher than that in the control group(125.36±4.58)°,t=7.043,P<0.001.The extension of the observation group was(49.58±5.85)°,which was higher than that of the control group(40.32±5.10)°,t=3.833,P<0.001.The abduction of the observation group was(153.74±15.19)°,which was higher than that of the control group(136.42±15.27)°,t=9.210,P<0.001.The adduction of the observation group was(37.14±4.25)°,which was higher than that of the control group(31.22±4.30)°,t=9.210,P<0.001.The body score of the observation group was95.25±1.20,which was higher than that of the control group(79.25±1.58),t=53.492,P<0.001.The cognitive score was 94.56±1.45,which was higher than that of the control group(79.25±1.52),t=48.344,P<0.001.The score of social function was 95.25±1.45,which was higher than that of the control group(78.25±1.14),t=53.129,P<0.001.The role score was 95.25±1.45,which was higher than that of the control group(78.25±1.14),t=53.129,P<0.001.The score of emotional function was 93.25±2.45,which was higher than that of the control group(73.25±1.99),t=48.826,P<0.001.Conclusions The intramuscular effect patch combined with freehand technique drainage is helpful to reduce the difference of bilateral upper arm circumference and prevent lymphedema in patients with breast cancer after operation.The upper limb function,shoulder joint activity and quality of life of patients after operation are better.