虚拟认知康复训练对保留乳头乳晕青年乳腺癌改良根治术后即刻乳房再造患者预后的影响

Effect of virtual cognitive rehabilitation training on the prognosis of young breast cancer patients with immediate breast reconstruction after modified radical mastectomy with nipple-areola preservation

目的探讨虚拟认知康复训练对保留乳头乳晕青年乳腺癌改良根治术后即刻乳房再造患者预后的影响。方法选取2017年5月至2020年5月海口市人民医院收治的126例青年乳腺癌患者纳入研究,使用随机数字表法将其分为观察组和对照组,每组各63例。两组患者均行保留乳头乳晕乳腺癌改良根治术治疗,术后即刻行乳房再造。对照组患者术后接受常规康复训练,观察组患者术后接受虚拟认知康复训练,两组患者训练均持续8周。比较两组患者术后并发症发生率,术后8周康复训练依从性、肩关节活动度、日常生活能力和生活质量,以及术后1 d、术后8周认知功能变化。结果观察组患者术后并发症发生率显著低于对照组(P<0.05)。术后8周,观察组患者康复训练依从率、乳腺癌生命质量测定量表生理状况、功能状况、社会/家庭状况、情感状况、附加关注评分均显著高于对照组(均P<0.05),肩关节内旋、前屈、外展、后伸、外旋、内收活动度及手指爬墙高度均显著大于对照组(均P<0.05),日常生活能力评定量表基本性日常生活能力、工具性日常生活能力评分和总分均显著低于对照组(均P<0.05)。术后8周,两组患者蒙特利尔认知评估(Montreal cognitive assessment,MoCA)量表各维度评分和总分均显著高于本组术后1 d(均P<0.05),观察组患者MoCA量表各维度评分和总分均显著高于同期对照组(均P<0.05)。结论保留乳头乳晕青年乳腺癌改良根治术后即刻乳房再造患者进行术后虚拟认知康复训练,能够降低术后并发症发生率,提高康复训练依从性,改善患者肩关节功能,提高日常生活能力、生活质量和认知功能。

Objective To analyze the effect of virtual cognitive rehabilitation training on the prognosis of young breast cancer patients with immediate breast reconstruction after modified radical mastectomy with nipple-areola preservation.Method A total of 126 young breast cancer patients admitted to Haikou People's Hospital from May 2017 to May 2020 were included in this study.They were divided into observation group and control group by random number table method,with 63 cases in each group.Both groups of patients received modified radical mastectomy with nipple-areola preservation and immediate breast reconstruction.Patients in control group received routine postoperative rehabilitation training,and patients in observation group received virtual cognitive rehabilitation training.The training lasted for 8 weeks in both groups.The incidence of postoperative complications,rehabilitation training compliance,shoulder joint activity,activities of daily living and quality of life at 8 weeks after operation,and the changes of cognitive function at 1 day and 8 weeks after operation were compared between the two groups.Result The incidence of postoperative complications in observation group was significantly lower than that in control group(P<0.05).Eight weeks after operation,observation group compliance rate of rehabilitation training,the scores of physiological status,functional status,social/family status,emotional status and additional attention of functional assessment of cancer therapy-breast were significantly higher than those in control group(all P<0.05);the shoulder joint internal rotation,forward flexion,abduction,extension,external rotation,adduction activity and finger climbing height were significantly higher than those in control group(all P<0.05);the scores of basic daily living ability,instrumental daily living ability and total score of activity of daily living scale were significantly lower than those in control group(all P<0.05).At 8 weeks after operation,the scores of all dimensions and total scores of Montreal cognitive assessment(MoCA)scale in the two groups were significantly higher than those at 1 day after operation(all P<0.05),the scores of all dimensions and total scores of MoCA scale in observation group were significantly higher than those in control group at the same period(all P<0.05).Conclusion For young patients with breast reconstruction after modified radical mastectomy with nipple-areola preservation,postoperative virtual cognitive rehabilitation training can reduce the incidence of postoperative complications,improve the compliance rate of rehabilitation training,improve shoulder joint function,daily life ability,quality of life and cognitive function.