渐进式康复护理对乳腺癌术后肩关节活动度及生命质量的影响

The impact of the progressive rehabilitative program on ipsilateral range of motion and quality of life of the breast cancer patients after modified radical mastectomy

目的设计适合乳腺癌患者改良根治术后肢体锻炼的渐进式康复操,并综合心理社会干预,对渐进式康复护理改善乳腺癌患者改良根治术后肩关节活动度和生命质量的效果进行评价。方法按照区组随机化分组的方法,将样本分为干预组和对照组各46名。对照组患者接受乳腺癌术后常规护理。干预组患者接受常规护理的同时,给予6个月的渐进式康复护理,包括早、中、晚三套渐进式康复操,乳腺癌康复讲座和个体化咨询。以肩关节活动度和健康相关生命质量为主要指标,分别在术后10d、1个月、3个月和6个月对干预效果进行评价。结果①干预后干预组患者肩关节活动度在术后10d、1个月、3个月和6个月显著大于对照组,差别有统计学意义(P<0.01);②重复测量方差分析显示,干预组肩关节活动度的恢复趋势显著快于对照组(P<0.05);③重复测量方差分析显示,干预组健康相关生命质量总分的得分趋势明显低于对照组(P<0.01),提示干预组健康相关生命质量优于对照组。结论渐进式康复护理是减少乳腺癌患者术后上肢功能障碍,提高健康相关生命质量的有效方法。

Objective To develop a progressive rehabilitative program,including exercises and psychosocial interventions,for breast cancer patients who received modified radical mastectomy （MRM）. The effect of the progressive programs on the range of motion （ROM） and quality of life（ QOL ） were evaluated. Methods Ninty-two breast cancer patients were randomly assigned into intervention group （IG） and control group（CG） using the blocked randomization with 46 patients in each group. Those in IG attended 6-month rehabilitative program in addition to routine care, while CG received routine care only. Several forms of intervention were included. The progressive exercises consisted of stage Ⅰ ,Ⅱ and Ⅲ exercises. Four collective workshops were carried out. Individual consultation was provided in IG. Measurements of ROM and health related quality of life （HRQOL） were taken 10 days, 1 month, 3 months and 6 months after the operations respectively. Results （1） After the intervention, the improvement of ROM were greater significantly in IG than in CG on the 10^th postopera- tive day, as well as the 1^st, 3^rd and 6^th postoperative month （P〈0.01）. （2） The results of repeated- measures ANOVA indicated that IG showed a better recovery of ROM（P〈0.05）. （3）The results of repeated-measures ANOVA showed that the scores of HRQOL in IG were lower obviously compared to those in the CG（P〈0.01）, indicating an improving HRQOL in IG. Conclusions The progressive rehabilitative program is an effective approach in ameliorating the dysfunction of upper limbs and improving the HRQOL of breast cancer patients.