一例乳腺癌患者手术后的循证护理

The Nursing Intervention for Patient with Breast Cancer Who has Accepted Surgery Based on Best Clinical Evidence

目的根治(或改良根治)乳房切除手术后理疗可以减轻患者皮下积液、血肿,患侧肩功能活动障碍,但是术后何时进行患侧肩关节功能锻炼还存在争议。本文针对1例乳腺癌患者,检索当前最佳证据并进行评价,为临床合理治疗提供依据。方法计算机检索Cochrane图书馆、Medline、EMbase、中国生物医学文献数据库(CBMdi-sc)、中国期刊全文数据库(CJFD)、中文科技期刊数据库(VIP)的随机对照试验(randomized controlled trials RCT)和Meta分析,检索时间从数据库建立至2008年5月。检索词包括"breast neoplasm,""breast cancer,""breast carcino-ma,""mastectomy,""modified radical mastectomy,""radical mastectomy,""shoulder function,""seromas,""shoulder exer-cises,"combined with"randomized controlled trials,""randomized controlled trial,""random allocation,""乳腺癌、乳腺肿瘤、乳癌、手术、根治手术、改良手术、肩功能、肩关节锻炼、随机"。对所获得的证据按照循证医学评价证据的原则进行质量评价。结果共筛选出3篇RCT。检索出的证据表明,对于行根治(或改良根治)乳房切除手术的患者,术后开始何时开始理疗只影响创面液体引流量,而与患侧肩关节的功能恢复无关。该患者手术后9d开始理疗,术后恢复顺利,术后3个月、6个月及9个月评价患侧肩关节功能良好。结论实施根治(或改良根治)乳房切除手术的患者,我们推荐术后9d以后再开始理疗。

Objective Seromas and impaired shoulder function are well-known complications after modified radical mastectomy for breast cancer.Early postoperative physiotherapy is a common treatment to avoid shoulder dysfunction.The aim of this study was to analyze and explain when to treat a patient with breast cancer who has accepted surgery based on best clinical evidence.Methods We searched Cochrane library.Methods EMbase,CBM disc,CJFD and VIP(up to May 2007),to find the best clinical evidence and evaluated the quality of evidence.We used the following Medical Subject Heading(MeSH)terms and/or text words:'breast neoplasm,' 'breast cancer,' 'breast carcinoma,' 'mastectomy,' 'modified radical mastectomy,' 'radical mastectomy,' 'shoulder function,' 'seromas,' 'shoulder exercises,' combined with 'randomized controlled trials,' 'randomized controlled trial,' 'random allocation'.Results We found that 3 randomized controlled trials(RCTs)were eligible and were evaluated.According to the evidence,the incidence of seromas after modified radical mastectomy or radical mastectomy for breast cancer is reduced by delaying shoulder exercises,but there was no significant difference between the early group and later group in the late outcome of shoulder function.The patient with breast cancer accepted physiotherapy after surgery in ninth day and was smoonsly out of hospital.Conclusion Ninth day after modified radical mastectomy or radical mastectomy for breast cancer is suitable for patients with breast cancer who has accepted modified radical mastectomy or radical mastectomy.