乳腺癌患者术后早期功能锻炼最佳证据的临床应用

    Clinical Application of the Best Evidence for Early Functional Exercise in Breast Cancer Patients Undergoing Surgery

    • 摘要:
      目的 将乳腺癌术后患肢早期功能锻炼的最佳证据应用于临床实践,并评价应用效果。
      方法 构建以最佳证据为基础的乳腺癌患者术后患肢早期功能锻炼方案,制作锻炼视频和锻炼日记等工具,开展护士培训和患者教育。用查检表和乳腺癌患者生命质量测定量表进行效果审查。
      结果 与基线审查组相比,证据应用后护士进行术前评估和术后效果评价的执行率、患者术后第8天开始行肩关节活动的比率、引流管拔除前行跨越头顶的肩关节活动的比率和功能锻炼达标率均显著提高(P < 0.05)。但两组患者总体生活质量、引流管留置天数无显著差异(P > 0.05)。干预后患者术后1个月的前屈位活动度为137.46°(± 2.67°),后伸位54.13°(± 0.77°),外展位136.87°(± 3.30°);轻度淋巴水肿的发生率为4例(8.3%)。
      结论 最佳证据的应用可完善乳腺癌患者术后患肢早期功能锻炼方案,提高患者的锻炼依从性,改善患者的肩关节活动度,但未延长患者术后引流管留置天数,对术后生活质量改善效果不大。

       

      Abstract:
      Objective To apply the best evidence of early functional exercise of affected limbs undergoing breast cancer surgery to clinical practice and evaluate its effects.
      Methods The early functional exercise program for breast cancer patients' affected limbs based on the best evidence was developed. The exercise videos and exercise diaries were made, and nurse training and patient education were implemented. The quality audit indicators and Functional Assessment of Cancer Therapy Scale - Breast (FACT-B) were used to evaluate the effects.
      Results After the application of evidence, the execution rate of preoperative evaluation and postoperative effect evaluation by nurses, the proportion of patients who started shoulder joint activity on the 8th day after surgery, the rate of shoulder joint activity crossing the head before drainage tube removal, and the compliance rate of functional exercise significantly increased (P < 0.05). However, there was no significant difference in overall quality of life and days of drainage tube retention between the two groups of patients (P > 0.05). After the intervention, the range of motion in the anterior flexion position was 137.46° (± 2.67°), in the posterior extension position was 54.13° (± 0.77°), and in the lateral extension position was 136.87° (± 3.30°) in the review group patients one month after surgery. And the incidence of mild lymphedema was 4 cases (8.3%).
      Conclusion The application of the best evidence can help establish and perfect the early functional exercise program of the affected limb of breast cancer patients undergoing surgery, improve the exercise compliance of patients, improve the patient's shoulder joint range of motion, do not extend the days of indwelling drainage tube after surgery, but have little effect on improving the quality of life after surgery.

       

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