六步综合消肿疗法在重度Ⅲ级下肢淋巴水肿中的应用效果分析

Effect of complete decongestive therapy in severe gradeⅢlower limb lymphedemabv

目的探讨6步综合消肿疗法在重度Ⅲ级下肢淋巴水肿的应用效果。方法2018年1—12月,选取中山大学肿瘤防治中心淋巴水肿门诊收治的重度Ⅲ级下肢淋巴水肿患者7例,采用6步综合消肿疗法对患者进行干预。包括问题皮肤护理、特殊技术徒手淋巴引流、泡沫块绷带联合空气波压力治疗、填充型弹性绷带加压包扎、功能锻炼联合居家徒手淋巴引流、减重管理。以20次为1个疗程,共2个疗程40次综合消肿疗法。在治疗第0、5、10、15、20、30、40次分别采取周径测量法,体质量测量以评价治疗效果。结果治疗2个疗程后,患侧各测量点的周径值均低于治疗前,差异有统计学意义(F值为7.449~23.073,P<0.05),患侧的周径减小了7.10~24.53 cm,治疗后的体质量比治疗前减轻了9.0~20.5 kg。随访期间发现,5个部位随访3个月时下肢周径值与随访1年时相比,疗效增加并趋于稳定。结论6步综合消肿疗法能够明显改善本研究患者下肢淋巴水肿症状,且在后续随访发现,居家自我治疗中,患肢肿胀没有复发或程度加重,且能减轻或维持治疗效果,增强患者对治疗的信心,从而提高患者的生命质量和治疗的依从性。

Objective To investigate the effect of complete decongestive therapy in the treatment of severe gradeⅢlower limb lymphedema.Methods From January 2018 to December 2018,The patients were admitted to the lymphedema clinic of the cancer prevention and treatment center of Sun Yat-sen University,seven patients with severe gradeⅢlower limb lymphedema were intervened with complete decongestive therapy,including problem skin care,special techniques of unarmed lymphatic drainage,foam block bandage combined with air wave pressure therapy,filled elastic bandage pressure bandage,functional exercise combined with home bare-handed lymphatic drainage and weight loss management.The intervention had two courses,and 20 times was a course of treatment.Perimeter measurement and weight measurement were used to evaluate the therapeutic effect at the 0,5,10,15,20,30,40 times of treatment.Results After two courses of treatment,the circumference value of each measurement point on the affected side was lower than that before treatment,and the difference was statistically significant(F values were 7.449-23.073,P<0.05).The circumference value of the affected side decreased by 7.10-24.53 cm,and the weight after treatment was 9.0-20.5 kg less than that before treatment.During the follow-up period,it was found that the lower extremity diameter value at 3 months of follow-up at 5 sites increased and tended to be stable compared with that at 1 year of follow-up.Conclusion Step 6 comprehensive swelling treatment can obviously improve the symptoms of patients with lower limb lymphedema of this research,and in the subsequent follow-up found that self-therapy at home,no recurrence or aggravate the limb swelling degree,and can reduce or stability treatment effect,enhance confidence in the treatment of patients,so as to improve the quality of life of patients and treatment compliance.