中药热熨与艾灸联合肢体功能锻炼与心理护理干预乳腺癌术后腋网综合征临床研究

Clinical Study on Hot Medicinal Compress of Chinese Medicine and Moxibustion Combined with Functional Exercise of Limbs and Psychological Nursing in Intervening Axillary Web Syndrome After Surgery for Breast Cancer

目的:观察在患肢功能锻炼和心理护理的基础上加用中药热熨联合艾灸干预乳腺癌术后腋网综合征(AWS)的临床效果。方法:将100例乳腺癌术后AWS患者随机分为对照组和观察组各50例。对照组予美洛昔康片、电磁波治疗仪治疗,行患肢功能锻炼,并予心理护理。观察组在患肢功能锻炼和心理护理的基础上加用中药热熨联合艾灸治疗。2组均治疗4周。分别于治疗前与治疗1周、2周、3周、4周进行疼痛视觉模拟评分法(VAS)评分,记录疼痛及条索样结节消失时间,治疗前与治疗4周后评测上肢功能评分表(DASH)评分。比较2组的临床疗效。结果:治疗4周后,观察组临床疗效优于对照组(P<0.05)。2组治疗后VAS评分均逐渐下降(P<0.01),观察组治疗1周、2周、3周及4周的VAS评分均低于对照组(P<0.01)。观察组疼痛及条索样结节消失时间均较对照组缩短(P<0.01)。2组DASH的A部分评分、B部分评分及总分均较治疗前下降(P<0.01)。观察组A部分评分、B部分评分及总分均低于对照组(P<0.01)。结论:在患肢功能锻炼和心理护理的基础上加用中药热熨联合艾灸,可显著改善AWS的疼痛、条索样结节等症状,缩短病程,促进肢体功能的恢复,临床疗效优于单纯实施现代医学干预措施。

Objective:To observe the clinical effect of the additional intervention of hot medicinal compress of Chinese medicine combined with moxibustion on axillary web syndrome(AWS)after surgery for breast cancer based on functional exercise of affected limbs and psychological nursing.Methods:A total of 100 cases of AWS patients after surgery for breast cancer were randomly divided into the control group and the observation group,50 cases in each group.The control group was given meloxicam tablets,systemic therapy like electromagnetic therapeutic apparatus,functional exercise of affected limbs,and psychological nursing.Based on functional exercise of affected limbs and psychological nursing,the observation group was additionally given the application of hot medicinal compress of Chinese medicine combined with moxibustion.Both groups were treated for four weeks.Before treatment as well as on the week 1,2,3,and 4 of treatment,the scores of Visual Analogue Scale(VAS)for pain were evaluated;the disappearance time of pain and cord-like nodules was recorded.Before treatment and after four-week treatment,the scores of Disability of the Arm,Shoulder and Hand Scale(DASH)were evaluated.The clinical effect in the two groups was compared.Results:After four-week treatment,the clinical effect in the observation group was better than that in the control group(P<0.05).After treatment,the scores of VAS in the two groups were gradually decreased(P<0.01).On the week 1,2,3,and 4 of treatment,the scores of VAS in the observation group were lower than those in the control group(P<0.01).The disappearance time of pain and cord-like nodules in the observation group was shorter than that in the control group(P<0.01).The scores of part A and part B in DASH Scale as well as the total scores in the two groups after treatment were decreased when compared with those before treatment(P<0.01);the above three scores in the observation group were lower than those in the control group(P<0.01).Conclusion:Based on functional exercise of affected limbs and psychological nursing,the additional application of hot medicinal compress of Chinese medicine combined with moxibustion has better clinical effect than that of simple application of intervention measures of modern medicine,which can significantly improve symptoms of AWS including pain and cord-like nodules,shorten course of disease,and promote recovery of limb function.