乳腺癌患者腋窝淋巴清扫术后上肢自我感觉症状分布特点及症状群研究  

Arm symptoms and symptoms clusters for breast cancer patients after axillary lymph node dissection

作　　者：王玲[1] 周丽华[2] 王营营[3] 汪苗[1] 潘庆[1] 

机构地区：[1]皖南医学院护理学院,安徽芜湖241002 [2]皖南医学院附属弋矶山医院 [3]安徽省立医院

出　　处：《护理学杂志》2016年第12期20-23,共4页Journal of Nursing Science

基　　金：安徽省高校省级自然科学研究项目(KJ2013Z110);皖南医学院校中青年自然科学基金项目(WK201416)

摘　　要：目的探讨乳腺癌患者腋窝淋巴清扫术后上肢自我感觉症状以及症状群的分布特点,为症状管理提供指导。方法选取乳腺癌腋窝淋巴清扫术后患者343例为研究对象,采用自编的上肢自我感觉症状调查表对其进行调查。结果患者上肢存在多种症状,发生率最高的3个症状分别是紧缩感（62.39%）、僵硬感（59.48%）、麻木感（42.86%）。上肢疼痛感（47.94%）、压痛感（17.81%）在术后3个月内发生率最高,随着术后时间延长,发生率逐渐降低且差异有统计学意义（均P〈0.01）;上肢紧缩感（79.10%）、麻木感（55.22%）、僵硬感（77.61%）、感觉迟钝（28.36%）、无力感（58.21%）在术后3~6个月发生率最高,其中紧缩感、麻木感、僵硬感、无力感4个症状随术后时间的延长,发生率逐渐降低且差异有统计学意义（P〈0.05,P〈0.01）;上肢沉重感（32.20%）、肿胀感（37.29%）在术后12~24个月发生率最高,术后不同时间段发生率比较,差异无统计学意义（均P〉0.05）。探索性因子分析得出4个症状群：因子1为瘢痕组织牵拉相关症状群（紧缩感、僵硬感）;因子2为手术创伤相关症状群（疼痛感、压痛感、无力感）;因子3为上肢淋巴水肿相关症状群（沉重感、肿胀感）;因子4为肋间臂神经损伤相关症状群（感觉迟钝、麻木感）。结论乳腺癌患者腋窝淋巴清扫术后存在多个症状,且以群集现象存在。护理人员进行症状管理时根据症状分布和群集特点采取针对性的干预措施,以减轻患铡上肢不适感。Objective To explore arm symptoms of breast cancer patients after axillary lymph node dissection to identify arm symptom clusters,so as to provide information for symptom management.Methods A total of 343 breast cancer patients after axillary lymph node dissection were recruited and their arm symptoms were investigated using a self-made questionnaire.Results Various arm symptoms were identified in patients with breast cancer after axillary lymph node dissection.The most prevalent symptom was tightness（62.39%）,followed by stiffness（59.48%）and numbness（42.86%）.The incidence of pain（47.94%）and tenderness（17.81%）ranked the highest at 3months after surgery and then decreased with the extension of time significantly（P〈0.01 for both）.Three to six months after surgery,the incidence of tightness（79.10%）,numbness（55.22%）,stiffness（77.61%）,weakness（58.21%）and dysesthesia（28.36%）were highest,and then that of the first four reduced with the extension of time significantly（P〈0.05,P〈0.01）.The occurrence of heaviness in upper limbs（32.20%）and swelling（37.29%）ranked the highest 12-24 months after surgery and then also reduced with the extension of time but without significant differences（P〉0.05 for both）.Exploratory factor analysis of symptoms revealed four major symptom clusters as scar tissue tension（tightness-stiffness）,surgery trauma（pain-tenderness-weakness）,arm lymphedema（heaviness-swelling）,and intercostobrachial nerve injury（dysesthesia-numbness）.Conclusion Symptom clusters are identified in breast cancer patients after axillary lymph node dissection.Recognition of arm symptoms and symptoms clusters can be useful for nurses to assess and provide effective interventions.

关 键 词：乳腺癌 腋窝淋巴清扫术 症状群 上肢 

分 类 号：R473.6[医药卫生—护理学]