Effectiveness of six-step complex decongestive therapy for treating upper limb lymphedema after breast cancer surgery

BACKGROUND Complex decongestive therapy(CDT)is currently recommended as the standard treatment for lymphedema.CDT is a four-step detumescence therapy that can effectively treat upper limb lymphedema after breast cancer surgery,and is considered non-invasive,painless and without side effects.AIM To determine the effectiveness of a six-step CDT involving a foam granule bandage for the treatment of upper extremity lymphedema pressure after breast cancer surgical intervention.METHODS The study included 100 patients with upper extremity lymphedema after breast cancer surgery.The surgical methods were mastectomy plus axillary lymph node dissection and breast preservation plus sentinel lymph node biopsy.The study population was further divided into the experimental group and control group with 50 cases in each group.The control group was given conventional CDT(four-step method),which included skin care,freehand lymphatic drainage,foam granule pressurized bandage,and functional exercise.In the experimental group,a six-step CDT method was applied that involved a foam particle bandage combined with air wave pressure therapy in addition to the four steps of conventional CDT.Patients in both groups were given one course of treatment daily(20 times),and the changes in body moisture and subjective symptoms were measured before and after treatment,preoperatively and 20 times after treatment.RESULTS No statistically significant differences in 50-Hz bioelectrical impedance and extracellular moisture ratio were observed between the two groups before treatment,suggesting comparability of the baseline data.After treatment,the 50-Hz bioelectrical impedance of the experimental group was significantly higher than that in the control group,and the extracellular moisture ratio was significantly lower than that in the control group.A comparison of the differences between the two groups before and after treatment indicated that the treatment effect in the experimental group was better than that in the control group.After 20 treatments,according to subjective evaluations,the tightness and swelling of the limbs in the experimental group were significantly reduced as compared with those in the control group.CONCLUSION The six-step CDT method can effectively reduce lymphedema,promote lymphatic circulation,and alleviate the subjective symptoms of patients,and thereby improve the quality of life and treatment compliance among patients.

Clinical experience in treating 78 cases of upper limb edema after breast cancer operation by WenYang HuoXue Washing Prescription

观察中药温阳活血泡洗法治疗乳腺癌术后上肢水肿的临床疗效及安全性.方法给予符合入组标准的 78例阴证乳腺癌术后上肢水肿患者温阳活血泡洗方患臂湿敷及护理指导,观察治疗前、治疗后 14d患肢症状评分,最终评价临床总有效率.结果：显效23例,有效 41例,无效14例,总有效率为 82.1%,而根据水肿分期Ⅰ期与Ⅱ期比较,两组无显著性差异（P〉0.05）;研究期间未发生任何不良事件.结论：中药温阳活血泡洗方能有效改善乳腺癌术后上肢水肿寒症患肢不适症状,值得临床推广应用.

Traditional Chinese combined with western therapy in treatment of upper extremity edema after breast cancer surgery: A meta-analysis

Objective:To evaluate clinical efficacy by traditional Chinese combined with western therapy to treat upper extremity edema after breast cancer surgery.The clinical efficacy was described by the effective rate and the change of peripheral diameter of the affected limb.Methods:National Knowledge Internet(CNKI),Wan Fang Digital Journals(Wan Fang),VIP Chinese periodical service platform(VIP),Chinese biomedical literature service system(CBM),PubMed and EMBASE were searched on computer.And clinical randomized controlled trials(RCT)of the treatment of upper extremity edema after breast cancer surgery with integration of Chinese and western treatment were selected.The time was from January 2011 to May 2020.Upper extremity edema after breast cancer surgery was the first key word and the second was traditional Chinese combined with western therapy.Note Express was used to screen and extract literature.Bias risks of all the literature included in the study were evaluated and analyzed by RevMan5.3 software.Results:10 randomized controlled clinical tests,644 patients in conformity to the inclusion criteria,9 for the observation of curative effectiveness,5 of changes in limb circumference.322 cases were included in the observation group and the same number of cases in the control group,all of which were in Chinese.The results expressed that the curative effect in the observation group was 91.1%,and it was higher than the curative effect in the control group treated by single western treatment obviously,and it was only 68.9%[95%CI(1.22,1.44),Z=6.55,P<0.00001].The peripheral diameter shrinking degree of the affected limb in the observation group was also clearly higher than that in the control group which was healed by simple western treatment[95%CI(-0.98,-0.64),Z=9.40,P<0.00001].Conclusion:Traditional Chinese combined with western therapy treating upper extremity edema after the surgery of breast cancer had a notable clinical effect,which treated the disease and effectively lessened the peripheral diameter of the affected limb.The method was worthy of clinical application.However,owing to the low quality of the included documents,further discussion and learning were still needed.

Application of MET Technique after Upper Limb Dysfunction after Breast Cancer Surgery

Object:Explore the application and actual effect of MET(Muscle Energy)technology after breast cancer surgery with upper limb dysfunction.Methods:Taking 40 female breast cancer patients who underwent surgical treatment in our hospital from September 2017 to June 2019 as the research objects,all of them successfully completed modified radical mastectomy for breast cancer.According to different nursing methods,the patients were randomly divided into two groups.The experiment There were 20 cases in each group and the control group.The control group was given routine functional recovery exercise intervention after the operation,and the experimental group added MET technology to the base of the control group.One month after the operation,the functional recovery of the affected limbs of the two groups of patients was effectively assessed.The upper limb dysfunction of the two groups was compared by statistical methods,and the shoulder joint range of motion(ROM)was used for performance.Results:Through early functional recovery training and MET technology,19 cases of ROM in the experimental group showed compliance(95%),compared with only 14 cases(70%)in the control group.The difference in upper limb dysfunction between the two groups is very obvious with statistical significance(P<0.05).Conclusions:Early functional recovery training combined with muscle energy technology can promote the recovery of upper limb dysfunction after breast cancer surgery faster and better,which is conducive to the recovery of patients as soon as possible and improve the quality of life.

Transcutaneous Electrical Acupoint Stimulation Combined with Warm Acupuncture for Breast Cancer Related Upper Limb Lymphedema:A Retrospective Cohort Study

Objective To observe the clinical efficacy of transcutaneous electrical acupoint stimulation(TEAS)combined with warm acupuncture in treating breast cancer associated with upper limb lymphedema(BCRL).Methods This was a retrospective cohort study using a paired control design.Fifty-two BCRL patients were assigned to the control group(27 cases)and the treatment group(25 cases).The patients in the control group were treated with lymphedema comprehensive detumescence treatment(CDT)for 4 weeks,including systematic therapy composed of manual lymphatic drainage,compression bandage,skincare,and functional exercise.The patients in the treatment group were treated with TEAS combined with warm acupuncture based on the control group methods.Each treatment lasted for 30 min and was applied twice a week for 4 weeks.The arm circumference(AC)of different positions of the affected limb and the degree of swelling of the affected limb were evaluated before the first treatment and after the last treatment.The clinical efficacy was evaluated according to the degree of edema before and after treatment.All adverse events during treatment were recorded.Results The patients’AC and the swelling feeling of the affected limb in the treatment group and the control group were both reduced compared with those before treatment.Compared with the control group,AC of the wrist joint transverse stria,the midpoint between the wrist joint transverse stria and the elbow joint transverse stria in the treatment group were significantly reduced(P<0.05).The decrease in AC diameter at the midpoint between the elbow joint transverse stria and the axillary transverse stria was the most significant(P<0.01).The swelling degree of the affected limbs in the treatment group was significantly lower than before treatment,and was significantly lower compared with the control group after treatment(P<0.01).The total effective rate was 72%in the treatment group,significantly higher than that in the control group(55.56%,P<0.05).No serious adverse events occured in either group.Conclusions TEAS combined with warm acupuncture can effectively reduce AC and swelling feeling of the affected limb in patients with BCRL.The effect is better than that of CDT therapy alone.

穴位按摩联合艾灸治疗乳腺癌术后上肢淋巴水肿临床研究

目的:观察穴位按摩联合艾灸治疗乳腺癌术后上肢淋巴水肿的临床疗效。方法:采用随机数字表法将80例乳腺癌术后上肢淋巴水肿患者分为对照组、治疗组各40例。2组均给予地奥司明片治疗,对照组加用按摩与上肢功能锻炼治疗,治疗组加用穴位按摩联合艾灸治疗,2组连续治疗8周。比较2组临床疗效及治疗前后腺癌淋巴水肿症状体验指数(BCLE-SEI)、淋巴水肿纤维化分级、视觉模拟评分法(VAS)肿胀、VAS疼痛、乳腺癌患者生命质量测定量表(FACT-B)评分及上肢活动度。结果:治疗后,治疗组总有效率95.00%,高于对照组80.00%(P<0.05)。治疗后,2组中医证候积分、BCLE-SEI评分、淋巴水肿纤维化分级评分、VAS肿胀评分、VAS疼痛评分、FACT-B维度(生理、社会/家庭、情感、功能及其他状况)评分均较治疗前降低(P<0.05),且治疗组治疗后上述指标均低于对照组(P<0.05)。治疗后,2组上肢上举、内旋、外旋、水平屈曲及水平伸展活动度均较治疗前增大(P<0.05),且治疗组治疗后上述5项活动度高于对照组(P<0.05)。结论:穴位按摩联合艾灸治疗乳腺癌术后上肢淋巴水肿疗效确切,能够减轻患者患肢水肿和疼痛程度,促进上肢功能恢复,提高生活质量。

探讨渐进性康复训练配合预见性干预对乳腺癌术后患者上肢功能的影响

目的观察渐进性康复训练配合预见性干预对乳腺癌术后患者上肢功能的影响。方法100例乳腺癌术后患者,以随机数字表法分成对照组和研究组,各50例,对照组实施以常规的康复指导,研究组实施以渐进性康复训练配合预见性干预。比较两组干预前后的患侧肢体关节活动度、上肢运动功能、日常生活能力、自我干预能力及生活质量评分,术后并发症发生情况。结果两组干预患侧肢体后各方向活动度较干预前增加,研究组前屈、后伸、内旋、外旋、内收、外展活动度分别为(158.96±13.55)、(56.36±2.77)、(89.05±10.96)、(88.34±2.95)、(58.76±2.95)、(162.34±10.18)°,与对照组的(147.10±10.96)、(49.00±3.62)、(83.75±7.36)、(81.02±3.11)、(54.34±2.76)、(156.84±12.43)°相比更高,具有显著的差异性(P<0.05)。两组干预后上肢运动功能、日常生活能力、自我干预能力及生活质量较干预前增加,研究组上肢运动功能、日常生活能力、自我干预能力及生活质量评分分别为(52.58±6.61)、(91.15±3.99)、(94.43±3.11)、(92.26±3.42)分,高于对照组的(48.17±5.62)、(87.02±4.74)、(89.43±4.11)、(87.08±4.03)分,具有显著的差异性(P<0.05)。研究组患者术后并发症发生率6.00%低于对照组的22.00%,具有显著的差异性(P<0.05)。结论乳腺癌术后患者开展渐进性康复训练配合预见性干预,可改善患侧肢体的上肢各方向活动度,提升术后上肢运动功能、日常生活能力、自我干预能力及生活质量,减少术后并发症的发生。

多元化延续性干预在乳腺癌术后上肢淋巴水肿康复中的应用效果

目的分析多元化延续性干预在乳腺癌患者术后上肢淋巴水肿康复中的应用效果。方法根据干预方法的不同将96例乳腺癌手术患者分为对照组(n=47)和研究组(n=49),对照组患者采用常规干预,研究组患者在对照组的基础上采用多元化延续性干预。比较两组患者的满意度、上肢功能活动情况[臂肩手功能障碍评估表(DASH)]、上肢淋巴水肿情况。结果研究组患者的总满意度为97.96%,明显高于对照组患者的80.85%,差异有统计学意义(P﹤0.01)。干预后,两组患者DASH评分均明显低于本组干预前,研究组患者DASH评分明显低于对照组,差异均有统计学意义(P﹤0.01)。干预后,研究组患者上肢淋巴水肿情况优于对照组(P﹤0.05)。结论多元化延续性干预可减轻乳腺癌患者术后上肢淋巴水肿,促进患者上肢功能恢复,提高满意度,值得临床推广应用。

渐进式康复训练在促进乳腺癌术后患者上肢功能恢复中的应用研究

目的:分析渐进式康复训练对乳腺癌术后患者上肢功能恢复的效果。方法:选择2022年4月—2023年4月江门市妇幼保健院乳腺科收治的80例乳腺癌术后患者作为研究对象,按照入院先后顺序编号,将奇数号纳入对照组,偶数号纳入观察组,各40例。对照组给予常规康复护理,观察组在常规康复护理基础上开展渐进式康复训练。比较两组护理前、护理1个月后肩关节活动度、运动耐力、乳腺癌患者生存质量测定量表(FACT-B)评分、肩关节功能评分及术后恢复指标(下床活动时间、排便时间、排气时间)。结果:护理前,两组肩关节活动度、运动耐力指标、FACT-B评分及肩关节功能评分比较,差异无统计学意义(P>0.05)。护理1个月后,两组肩关节活动度优于护理前,运动距离长于护理前,心率恢复时间、最大心率时间短于护理前,FACT-B各项评分及肩关节功能各项评分高于护理前,且观察组肩关节活动度大于对照组,运动距离长于对照组,心率恢复时间、最大心率时间短于对照组,FACT-B各项评分及肩关节功能各项评分高于对照组,差异有统计学意义(P<0.05)。观察组术后下床活动时间、排便时间、排气时间均早于对照组,差异有统计学意义(P<0.05)。结论:乳腺癌患者术后开展渐进式康复训练可有效促进肩关节功能的恢复,还可增强患者的运动耐力并改善其生活质量。

智能康复锻炼器改善乳腺癌术后患者自我效能感及患肢功能的观察

目的探讨应用智能康复锻炼器在提升乳腺癌患者术后自我效能感、促进术后患肢功能恢复中的作用及改善术后上肢水肿的效果。方法选取2022年1月至2023年4月在嘉兴市中医医院行乳腺癌根治术+腋窝淋巴结清扫术的患者60例,根据随机数字表法将患者分为对照组(30例)和试验组(30例),对照组患者采用传统方法进行术后上肢功能锻炼,试验组患者采用智能康复锻炼器进行功能锻炼,比较两组患者术后3个月的自我效能感、功能锻炼依从性及术后1个月、3个月的肩关节活动度和上肢水肿发生率。结果术后3个月试验组患者的自我效能感、功能锻炼依从性均高于对照组(P<0.05);术后1个月和3个月试验组患者的肩关节活动度比较优于对照组(P<0.05);术后1个月试验组患者的上肢水肿发生率低于对照组,但差异无统计学意义(P>0.05),术后3个月试验组患者的上肢水肿发生率低于对照组,差异有统计学意义(P<0.05)。结论智能康复锻炼器可提升乳腺癌术后患者的自我效能感,提高功能锻炼依从性,促进患肢的功能恢复,防治术后上肢水肿,值得临床推广。

精细化护理在乳腺癌PICC置管化疗患者中的应用对导管相关性上肢深静脉血栓预防效果的价值探讨

目的探讨精细化护理在乳腺癌经外周静脉置中心静脉导管(Peripherally Inserted Central Venous Catheter,PICC)置管化疗患者中的应用及对导管相关性上肢深静脉血栓(Catheter Related Deep Venous Thrombosis of Upper Extremity,UEDVT)的预防效果。方法单纯随机选取2021年10月—2023年7月福建省三明市第二医院行PICC置管化疗的90例乳腺癌患者为研究对象,以随机数表法为依据分为两组,对照组(45例)实施常规护理,观察组(45例)基于对照组实施精细化护理,比较两组的UEDVT及其他置管事件发生情况、干预前后的腋下血液流速、血栓弹力图(Thromboelastography,TEG)参数以及生活质量。结果观察组UEDVT及其他置管事件的发生率(2.22%和4.44%)均低于对照组(17.78%和17.78%),差异有统计学意义(χ^(2)=4.444、4.050,P均<0.05)。干预后,观察组两项腋下血液流速指标(最大血液流速与静脉平均血液流速)均快于对照组,差异有统计学意义(P均<0.05)。干预后,观察组TEG参数中的R值高于对照组,MA值低于对照组,差异有统计学意义(P均<0.05)。干预后,观察组生活质量评分量表中的环境、社会、生理及心理得分均高于对照组,差异有统计学意义(P均<0.05)。结论精细化护理能够有效改善乳腺癌PICC置管化疗患者的腋下血液流速,预防UEDVT及其他置管事件发生,提升患者置管期间的生活质量。

乳腺癌患者术后1年内发生患侧上肢淋巴水肿的危险因素分析

目的探讨乳腺癌患者术后1年内发生患侧上肢淋巴水肿的危险因素。方法收集2021年3月至2022年3月于首都医科大学附属北京朝阳医院接受手术治疗的370例乳腺癌患者的临床资料。根据术后1年随访期间是否发生患侧上肢淋巴水肿将患者分为水肿组(n=67)和对照组(n=303)。收集并比较两组患者手术之前的基本资料,采用多因素Logistic回归模型进一步分析乳腺癌患者术后1年内发生患侧上肢淋巴水肿的危险因素。结果水肿组患者单身比例、体重指数、肿瘤分期为Ⅲ期的比例、淋巴结清扫数目≥10个的比例及术后接受放疗的比例均高于对照组患者,但术后采取针对性预防措施的比例低于对照组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,单身、体重指数≥27 kg/m^(2)、肿瘤分期为Ⅲ期、淋巴结清扫数目≥10个及术后接受放疗均为乳腺癌患者术后1年内发生患侧上肢淋巴水肿的独立危险因素,而术后采取针对性预防措施是乳腺癌患者术后1年内发生患侧上肢淋巴水肿的保护因素(P﹤0.05)。结论体重指数、单身、肿瘤分期、淋巴结清扫数目、术后是否接受放疗以及术后是否采取针对性预防措施均与乳腺癌患者术后1年内发生患侧上肢淋巴水肿密切相关,临床实践中可据此筛查高危患者,并协助、教育患者坚持积极的预防措施。

基于健康行为改变整合理论的乳腺癌患者患肢功能康复干预方案的应用研究

目的 探讨基于健康行为改变整合(ITHBC)理论的康复干预方案,对改善乳腺癌患者患肢功能的康复效果。方法 采取便利抽样法,选择2022年1-3月在我院乳腺肿瘤护理专科门诊因乳腺癌导致上肢功能障碍的90例患者为研究对象,按随机数字表法分为对照组和观察组,各45例,对照组接受常规的护理干预,观察组在对照组基础上实施基于ITHBC理论的护理干预。于干预前后比较2组患者的肩关节活动度、自我管理效能及生活质量。结果 干预4周后,2组患者肩关节前屈、后伸和外展的活动度组间比较,差异有统计学意义(P<0.05),2组患者自我管理效能和生活质量差异有统计学意义(P<0.05)。结论 基于ITHBC的康复干预方案可以改善乳腺癌患者的上肢功能,提升其生活品质以及自我管理效能。

基于IKAP模式的护理干预在乳腺癌术后患侧上肢淋巴水肿患者中的应用效果

目的观察基于信息-知识-信念-行为(IKAP)模式护理干预在乳腺癌术后患侧上肢淋巴水肿患者中的应用效果。方法将郑州大学第一附属医院2022年1月至2023年12月收治的74例乳腺癌术后患侧上肢淋巴水肿患者纳入本研究,按照随机数字表法,分为观察组与对照组。对照组(37例)接受常规护理,观察组(37例)在此基础上接受基于IKAP模式的护理干预。护理前后评价患者的疼痛程度、自我照护依从性、生活质量、自我管理能力,并比较两组护理满意度。结果护理后,观察组自我照护依从性提高、视觉模拟量表(VAS)评分下降,较之对照组更优(P<0.05);观察组正性态度、缓解压力、自我决策评分增高,较之对照组更高(P<0.05);观察组共性模板、乳腺癌特异模板、生活质量评分下降,较之对照组更低(P<0.05);观察组患者的护理总满意度为94.59%,与对照组的83.78%比较,观察组更高(P<0.05)。结论基于IKAP模式的护理干预可提高乳腺癌术后患侧上肢淋巴水肿患者的自我照护依从性,降低术后疼痛程度,提高患者自我管理能力与护理满意度,且生活质量更高。

三种运动疗法对乳腺癌术后患肢淋巴水肿患者上肢功能康复效果的网状Meta分析

目的:系统评价三种运动疗法对乳腺癌术后患肢淋巴水肿患者上肢功能的康复效果。方法:计算机检索CNKI、万方、维普、Web of Science、PubMed、The Cochran library、Medline、Embase等数据库,搜集2005年1月-2024年5月有关三种运动疗法干预乳腺癌术后患肢淋巴水肿患者上肢功能的随机对照试验(RCT)。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R软件与Addis软件进行网状Meta分析。结果:共纳入20项RCT,包括1736例乳腺癌术后患肢淋巴水肿患者。网状Meta分析结果显示,在乳腺癌术后患肢淋巴水肿患者手臂周径差康复方面,三种运动疗法均优于对照组(P>0.05);在乳腺癌术后患肢淋巴水肿患者上肢前屈康复方面,有氧训练干预治疗[MD=20.05(11.17,28.69),P<0.05]、抗阻训练干预治疗[MD=11.51(1.04,22.11),P<0.05]显著优于对照组的无干预治疗;在乳腺癌术后患肢淋巴水肿患者上肢后伸康复方面,有氧训练干预治疗[MD=7.72(3.67,11.54),P<0.05]、等速肌力训练干预治疗[MD=10.79(1.65,19.64),P<0.05]显著优于对照组的无干预治疗;在改善乳腺癌术后患肢淋巴水肿患者DASH评分方面,有氧训练干预治疗[MD=22.14(6.80,35.95),P<0.05]、等速肌力训练干预治疗[MD=11.48(1.16,22.34),P<0.05]显著优于对照组的无干预治疗。结论:根据定量合并证据显示,三种运动疗法均可有效改善乳腺癌术后患肢淋巴水肿患者上肢功能。等速肌力训练在干预乳腺癌术后患肢淋巴水肿患者手臂周径差,上肢前屈,上肢后伸,有氧训练在降低DASH方面更具优势。

乳腺癌根治术病人术后上肢淋巴水肿风险预测模型的构建及验证

目的:构建乳腺癌根治术病人术后上肢淋巴水肿的风险预测模型,并验证其预测应用效果。方法:选择2020年4月—2022年3月在徐州市妇幼保健院收治的乳腺癌根治术病人200例为训练集,采用Logistic回归分析筛选乳腺癌根治术病人术后上肢淋巴水肿的危险因素,据此构建风险预测模型;选取2022年4月—2023年4月收治的乳腺癌根治术病人50例为验证集,验证其预测效果。结果:训练集中共58例发生上肢淋巴水肿,发生率为29.00%;多因素分析结果显示,乳腺癌根治术病人术后上肢淋巴水肿的危险因素有体质指数(BMI)≥24 kg/m^(2)、肿瘤直径>5 cm、腋淋巴结清扫范围≥10个、术后辅助放疗、术后有并发症、术后无功能锻炼(P<0.05)。内部验证结果显示,ROC曲线下面积为0.863[95%CI(0.829,0.897),P<0.001];最佳风险截断值为24.38时,灵敏度为90.38%,特异度为85.73%,约登指数为0.761,模型预测准确率为84.00%。结论:本研究构建的风险预测模型能有效预测乳腺癌根治术后病人发生上肢淋巴水肿的风险。

渐进式阻力训练联合压力袖套对乳腺癌术后淋巴引流病人的效果观察

目的:探讨渐进式阻力训练(PRT)联合压力袖套对乳腺癌术后淋巴引流病人淋巴水肿自感症状、上肢运动功能及血清炎症因子水平的影响。方法:选取2019年12月—2021年12月在医院乳腺外科就诊的135例乳腺癌术后淋巴引流病人为研究对象,按照随机数字表法将其分为对照组(n=67)和观察组(n=68)。两组均给予45 min的徒手淋巴引流,对照组患肢佩戴压力袖套,观察组在对照组基础上给予PRT,观察两组血清炎症因子、生物电阻抗(BIS)和臂围情况、淋巴水肿自感症状及上肢运动功能。结果:干预6个月后,观察组白细胞介素-10(IL-10)、白细胞介素-6(L-6)、肿瘤坏死因子-α(TNF-α)水平低于对照组(P<0.05);第10次引流后,观察组淋巴水肿指数(L-Dex)水平和臂围均低于对照组(P<0.05);观察组干预6个月后淋巴水肿自感症状发生率较对照组低(P<0.05);观察组干预6个月后活动度大于对照组(P<0.05)。结论:PRT联合压力袖套能够降低乳腺癌术后淋巴引流病人的炎症反应,改善肢体水肿情况,提高上肢运动功能。

渐进性康复训练对乳腺癌术后上肢淋巴水肿、肢体功能和疼痛的影响

目的探讨渐进性康复训练对乳腺癌术后术后上肢淋巴水肿、肢体功能及疼痛的影响。方法回顾性分析2021年10月至2023年10月济宁医学院附属医院收治的100例乳腺癌手术患者的临床资料,根据随机抽样法均分为对照组、研究组,每组各50例。对照组给予术后常规康复指导,研究组给予术后渐进性康复训练。对比两组的上肢淋巴水肿情况、肢体功能、日常活动能力、疼痛程度、术后并发症发生情况。结果研究组上肢淋巴水肿程度低于对照组,肢体功能受损评分低于对照组,日常生活能力评分高于对照组,疼痛视觉模拟量表(VAS)低于对照组,术后并发症率低于对照组(均P<0.05)。结论对乳腺癌手术患者实施渐进性康复训练,在缓解上肢淋巴水肿、改善肢体功能及减轻上肢疼痛方面作用明显,可促使患者日常活动能力提升,并有助于减少术后并发症风险。

抽吸减容术治疗乳腺癌术后上肢淋巴水肿

目的探索抽吸减容术治疗不同程度乳腺癌术后上肢淋巴水肿的效果。方法回顾性分析2020年1月至2022年12月就诊的42例乳腺癌术后上肢淋巴水肿患者的临床资料。患者均为女性,年龄(57.19±8.79)岁;根据严重程度分为非重度组(25例)和重度组(17例),分析不同程度患者的临床特征,以及抽吸减容术治疗的效果。结果非重度组平均年龄为(54.6±8.85)岁,重度组平均年龄为(61.0±7.39)岁,差异有统计学意义(P=0.019)。术前非重度组BMI为(26.58±3.64)kg/m^(2),重度组BMI为(29.11±5.83)kg/m^(2),两组差异无统计学意义(P=0.091)。手术方式上,非重度/重度乳腺癌术后上肢淋巴水肿患者行淋巴水肿抽吸术,而少数极重度乳腺癌术后上肢淋巴水肿行淋巴水肿抽吸术联合病变组织切除术。非重度组与重度组相比,手术时间、注入膨胀液量、吸出脂肪悬浊液量、吸脂量、术中出血量均有统计学差异(P<0.01)。两组术毕及术后3个月肿胀程度均有明显改善(P<0.01),非重度组术毕及术后3个月的肿胀改善程度明显优于重度组,差异具有统计学意义(P<0.01)。结论抽吸减容术可以明显改善不同严重程度的乳腺癌术后上肢淋巴水肿。

乳腺癌手术患者上肢功能障碍危险因素分析及风险模型构建

目的:分析乳腺癌手术患者发生上肢功能障碍的危险因素,构建影响上肢功能障碍的危险因素风险模型并验证其性能。方法:2021年2月至2022年2月选取350例已行乳腺癌改良根治术2~5个月的女性患者进行非匹配的病例对照研究。经过Rowe肩关节评估量表评定,将评分<75分者作为病例组,评分≥75分者作为对照组。采用Logistic统计分析乳腺癌手术患者上肢功能障碍的危险因素,构建列线图风险预测模型并进行内部验证。结果:大学及以上文化水平、满意夫妻关系、高水平自我效能是乳腺癌手术患者上肢功能障碍的保护因素(P<0.05);年龄65~80岁、伤口痛、失眠、极少主动运动上肢、非常恐惧运动、复发乳腺癌、从不渴望娱乐活动、一点也不和朋友亲近是乳腺癌手术患者上肢功能障碍的危险因素(P<0.05)。将以上因素纳入并构建列线图风险预测模型,结果显示,伤口疼痛、夫妻关系、失眠、主动运动上肢等可干预因素对乳腺癌手术患者上肢功能障碍发生风险影响较大。内部验证结果显示模型的ROC曲线下面积为0.858。校正曲线表明列线图预测出的乳腺癌上肢功能障碍发生风险和实际发生风险之间有较好的一致性,校正后C指数为0.837。结论:构建的乳腺癌手术患者上肢功能障碍的危险因素风险模型的预测效果较好,可以辅助临床医护人员筛选影响上肢功能障碍的高风险因素,尤其是可干预的疼痛症状、失眠症状、主动运动行为及夫妻关系等,采取早期应对措施,促进术后康复。