加速康复外科模式在乳腺癌术后早期患肢功能恢复中的应用

Application of fast track surgery in early functional recovery of affected limbs after breast cancer surgery

目的探讨加速康复外科模式在乳腺癌术后早期患肢功能恢复中的应用。方法按照纳入及排除标准,选取2016年5月至2017年5月陆军军医大学西南医院医院收治的乳腺癌患者124例进行前瞻性研究,采用随机数字表法分为对照组和干预组,每组62例。对照组采用常规护理方法对患者进行患肢功能锻炼指导;干预组采用加速康复外科模式对患者进行术前宣教,术后由专人指导患肢功能锻炼,出院后由护理专家门诊评估并制定个体化锻炼方案及建立微信平台指导和督促。用t检验比较2组患者术后伤口恢复时间、引流时间以及住院时间的差异。在术后10 d、1个月及3个月,采用Constant-Murley肩功能测定标准评估患肢功能恢复情况,应用WHOQOL-BREF生活质量评定量表评估患者生活质量,并采用重复测量数据方差分析比较2组评分。结果干预组的术后伤口恢复时间、引流时间以及住院时间分别为(7.5±2.1)d、(6.3±2.4)d及(7.6±2.4)d,明显低于对照组的(10.3±3.2)d、(10.2±3.7)d及(10.2±4.2)d(t=5.762、6.963、4.232,P均<0.001)。干预组患者的术后患肢功能恢复情况评分优于对照组(疼痛:组间比较,F=94.553,P<0.001;时间点比较,F=723.882,P<0.001;交互作用,F=21.356,P=0.169;日常行为能力:组间比较,F=351.725,P<0.001;时间点比较,F=1681.920,P<0.001;交互作用,F=20.623,P<0.001;关节活动度:组间比较,F=441.381,P<0.001,时间点比较,F=2458.887,P<0.001;交互作用,F=28.420,P<0.001;肌力:组间比较,F=84.571,P<0.001;时间点比较,F=1474.775,P<0.001;交互作用,F=13.862,P<0.001)。干预组患者的术后生活质量评分也优于对照组(生活质量主观感觉:组间比较,F=235.607,P<0.001;时间点比较,F=607.245,P<0.001;交互作用,F=1.913,P=0.169;健康状况主观感觉:组间比较,F=140.170,P<0.001;时间点比较,F=618.834,P<0.001,交互作用,F=1.533,P=0.218;生理健康:组间比较,F=72.713,P<0.001,时间点比较,F=2324.181,P<0.001;交互作用,F=18.296,P<0.001;心理健康:组间比较,F=64.987,P<0.001;时间点比较,F=2613.833,P<0.001,交互作用,F=16.158,P<0.001;社会关系:组间比较,F=58.654,P<0.001;时间点比较,F=2775.791,P<0.001;交互作用,F=16.710,P<0.001;环境:组间比较,F=59.818,P<0.001;时间点比较,F=2638.321,P<0.001;交互作用,F=22.660,P<0.001)。结论加速康复外科模式对乳腺癌患者术后进行患肢功能锻炼的干预可以显著提高患者功能锻炼的依从性,提高患者的生活质量。

Objective To investigate the application of fast track surgery in early functional recovery of affected limbs after breast cancer surgery.Methods According to the inclusion and exclusion criteria,124 patients with breast cancer in the Southwest Hospital,Army Medical University from May 2016 to May 2017 were enrolled for a prospective study.The patients were divided into control group and intervention group by random number table,62 cases in each group.In control group,conventional nursing methods were used for functional exercises of limbs.In intervention group,fast-track surgery was applied,i.e.,preoperative and postoperative guidance on functional exercises of the affected limbs was given;after discharge,clinical nursing specialists made an individualized exercise program for each patient after evaluation in clinic and provided guidance and supervision by WeChat.The postoperative wound recovery time,duration of drainage and length of hospital stay were compared between two groups by t test.At postoperative 10 days,1 and 3 months,the Constant-Murley shoulder assessment was used to evaluate the functional recovery of the affected limbs and the WHOQOL-BREF quality of life assessment was used to evaluate the quality of life of breast cancer patients.The scores were compared between two groups using repeated measures analysis of variance.Results The recovery time of wound,duration of drainage and length of hospital stay were(7.5±2.1)d,(6.3±2.4)d and(7.6±2.4)d in intervention group,which were significantly lower than those in control group[(10.3±3.2)d,(10.2±3.7)d,(10.2±4.2)d;t=5.762,6.963,4.232,all P<0.001].The scores on postoperative limb function recovery in intervention group were superior to those in control group(pain:comparison between groups,F=94.553,P<0.001;time point comparison,F=723.882,P<0.001;interaction,F=21.356,P=0.169;daily mobility:comparison between groups,F=351.725,P<0.001;time point comparison,F=1681.920,P<0.001;interaction,F=20.623,P<0.001;range of motion of the joints:comparison between groups,F=441.381,P<0.001;time point comparison,F=2458.887,P<0.001;interaction,F=28.420,P<0.001;muscle strength:comparison between groups,F=84.571,P<0.001;time point comparison,F=1474.775,P<0.001;interaction,F=13.862,P<0.001).The scores on postoperative quality of life in intervention group were also significantly better than those in control group(subjective feeling on quality of life:comparison between groups,F=235.607,P<0.001;time point comparison,F=607.245,P<0.001;interaction,F=1.913 P=0.169;subjective feeling on health status:comparison between groups,F=140.170,P<0.001;time point comparison,F=618.834,P<0.001;interaction,F=1.533,P=0.218;physical health:comparison between groups,F=72.713,P<0.001;time point comparison,F=2324.181,P<0.001;interaction,F=18.296,P<0.001;mental health:comparison between groups,F=64.987,P<0.001;time point comparison,F=2613.833,P<0.001;interaction,F=16.158,P<0.001;social relationship:comparison between groups,F=58.654,P<0.001;time point comparison,F=2775.791,P<0.001;interaction F=16.710,P<0.001;environment:comparison between groups,F=59.818,P<0.001;time point comparison,F=2638.321,P<0.001;interaction,F=22.660,P<0.001).Conclusion The mode of fast track surgery can significantly improve early functional exercises of affected limbs in breast cancer patients after surgery,increase their compliance and ameliorate their quality of life.