综合消肿治疗联合互联网护理指导在乳腺癌相关淋巴水肿护理门诊中的应用  

Application of complex decongestive therapy combined with internet nursing guidance in breast cancer-related lymphedema nursing clinic

作　　者：徐海萍[1] 孙莉 王开慧[1] 卢静[3] 岳朝丽 王水[1] Xu Haiping;Sun Li;Wang Kaihui;Lu Jing;Yue Chaoli;Wang Shui(Department of Breast Diseases,Jiangsu Provincial Hospital,Nanjing 210036,China;Department of Nursing,Jiangyin People’s Hospital,Jiangyin 214400,China;Department of Acupuncture and Moxibustion,Jiangsu Provincial Hospital,Nanjing 210036,China)

机构地区：[1]江苏省人民医院乳腺病科,南京210036 [2]江阴市人民医院护理部,214400 [3]江苏省人民医院针灸科,南京210036

出　　处：《中华乳腺病杂志（电子版）》2021年第6期359-365,共7页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：江苏省妇幼健康科研项目(F201821);江苏省人民医院“临床能力提升工程”资助项目(JSPH-NB-2020-5);南京医科大学护理研究中心肿瘤护理研究分中心开放课题(NYZLKF-2-202104);江苏省人民医院“511腾飞工程”资助项目(JSPH-511C-2018-8)。

摘　　要：目的探讨综合消肿治疗(CDT)联合互联网护理指导在乳腺癌相关淋巴水肿(BCRL)护理门诊中的应用效果。方法采用便利抽样的方法前瞻性选取2019年1月~2020年6月在江苏省人民医院乳腺病科护理门诊就诊的145例乳腺癌术后BCRL患者为研究对象,对照组72例,干预组73例。对照组接受CDT治疗及常规护理指导,干预组在对照组基础之上增加互联网护理指导。采用秩和检验比较2组患者BCRL治疗前、治疗结束和治疗结束后6个月时患肢水肿程度;采用重复测量方差分析比较2组患者乳腺癌淋巴水肿症状指数(BCLE-SEI)量表中症状出现评分和症状困扰评分。结果(1)治疗结束6个月时2组患者水肿分级程度比较,差异有统计学意义(Z=-2.444,P<0.050)。(2)进行CDT联合互联网护理指导后,干预组BCLE-SEI量表中症状出现总分从(67.2±1.4)分降至治疗结束和治疗结束后6个月的(25.1±2.0)分和(38.2±1.4)分,而对照组3个时间点的总分分别为(66.5±1.4)分、(25.8±2.3)分和(48.4±1.9)分,2组比较,差异有统计学意义(F=19.338,P<0.001);同组患者各时间点的BCLE-SEI量表中症状出现总分差异有统计学意义(F=243.672,P<0.001);干预措施与时间对手指活动受限、上肢肿胀、胸壁肿胀、患肢紧绷、患肢沉重、患肢触痛压痛、患肢皮肤发热或发烫等7个项目评分及总分的的影响有交互作用,治疗结束后6个月时,2组患者上述评分比较差异有统计学意义(t=-2.945、-3.255、-3.101、-3.124、-3.187、-2.892、-3.233、-4.360,P=0.004、0.001、0.002、0.002、0.002、0.004、0.002、<0.001)。(3)干预组BCLE-SEI量表中症状困扰总分从(62.5±14.5)分降至治疗结束和治疗结束后6个月的(39.4±16.5)分和(36.9±15.6)分,而对照组3个时间点的总分分别为(63.8±15.3)分、(39.9±16.0)分和(45.1±18.2)分,2组比较差异无统计学意义(F=2.543,P=0.113);同组患者各时间点的BCLE-SEI量表中症状困扰总分差异有统计学意义(Objective To explore the application of complex decongestive therapy(CDT)combined with internet nursing guidance(ING)in the breast cancer-related lymphedema(BCRL)nursing clinic.Methods A total of 143 patients with postoperative BCRL in the lymphedema nursing clinic,Department of Breast Diseases,Jiangsu Provincial Hospital were enrolled into a prospective study by convenience sampling.The patients who were treated from January 2019 to June 2020.There were 72 cases in control group,and 73 cases in intervention group.In the control group,the patients received CDT and routine nursing guidance;in the intervention group,the patients received ING combined with CDT and routine nursing guidance.The rank sum test was used to compare the degree of edema in the arms between two groups before treatment,at the end of treatment and 6 months after treatment.The repeated measures analysis of variance was used to compare the scores of symptom occurrence and symptom distress in the breast cancer lymphedema symptom experience index(BCLE-SEI)scale.Results(1)At 6 months after treatment,there was a significant difference in the degree of edema between two groups(Z=-2.444,P<0.050).(2)After CDT combined with ING,the total score of symptom occurrence in the BCLE-SEI scale was decreased from 67.2±1.4 before treatment to 25.1±2.0 at the end of treatment and 38.2±1.4 at 6 months after treatment in intervention group,66.5±1.4,25.8±2.3 and 48.4±1.9 in control group,respectively,indicating a significant difference between two groups(F=19.338,P<0.001);the total score of symptom occurrence in the BCLE-SEI scale in the patients of the same group presented a significant difference among different time points(F=243.672,P<0.001);there was interactive effect between intervention measures and time in seven items(impaired mobility of fingers,arm swelling,chest wall swelling,tightness,heaviness and tenderness of limbs,increased temperature of skin)and the total score.At 6 months after treatment,the above-mentioned scores showed a significant differ

关 键 词：乳腺肿瘤 淋巴水肿 手术后医护 计算机通信网络 门诊医疗 

分 类 号：R473.6[医药卫生—护理学] R737.9[医药卫生—临床医学]