自我管理干预对乳腺癌患者预防和管理淋巴水肿效果的Meta分析  

Effect of self-management intervention on the prevention and management of lymphedema in breast cancer patients:a meta-analysis

作　　者：张紫娟 符鑫 胡倩 张力川 沈傲梅 王玉洁 陈姝宇 路潜[1] ZHANG Zijuan;FU Xin;HU Qian;ZHANG Lichuan;SHEN Aomei;WANG Yujie;CHEN Shuyu;LU Qian(Peking University School of Nursing,Beijing100191,P.R.China;Department of Nursing,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Henan University People's Hospital,Henan Provincial Key Medicine Laboratory of Nursing,Henan 450003,P.R.China)

机构地区：[1]北京大学护理学院,北京100191 [2]河南省人民医院河南省护理医学重点实验室,郑州450003

出　　处：《中国循证医学杂志》2024年第10期1177-1185,共9页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金项目(编号:72174011)。

摘　　要：目的系统评价各类自我管理干预措施对乳腺癌患者预防和管理淋巴水肿的效果。方法计算机检索Cochrane Library、Embase、PubMed、Web of Science、CINAHL、PsycINFO、SinoMed、CNKI、Wan Fang Data和VIP数据库,搜集有关自我管理干预措施对乳腺癌患者预防和管理淋巴水肿的干预性研究,检索时限均为建库至2023年6月16日,由两位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RevMan5.4软件进行分析。结果共纳入37篇文献,包括25篇随机对照试验,12篇临床对照试验,3697例患者。有26篇研究进行Meta分析,结果显示:与对照组相比,干预组患者在淋巴水肿管理相关行为[SMD=2.65,95%CI(1.53,3.78),P<0.01]、淋巴水肿相关症状[SMD=-2.01,95%CI(-3.66,-0.37),P<0.05]、淋巴水肿发生情况[RR=0.37,95%CI(0.32,0.45),P<0.01]、上肢功能[SMD=-1.88,95%CI(-2.83,-0.92),P<0.01]、生活质量[SMD=2.79,95%CI(2.05,3.54),P<0.01]方面表现更好,差异有统计学意义。干预措施主要包括信息支持、物质支持、情绪支持及决策支持四个方面。结论目前自我管理干预措施多样,但以信息支持为主。自我管理干预能够改善乳腺癌患者淋巴水肿自我管理的行为并降低淋巴水肿对于患者的影响。Objective To systematically review the effect of self-management intervention on the prevention and management of lymphedema in breast cancer patients. Methods The Cochrane Library, Embase, PubMed, Web of Science, CINAHL, PsycINFO, SinoMed, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on self-management intervention on the prevention and management of lymphedema in breast cancer patients,from inception to June 16. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.4 software. Results A total of 37 references were included, comprising 25 randomized controlled trials(RCTs), 12 controlled clinical trials(CCTs), and a total of 3 697patients. There were 26 studies in the meta-analysis, and the results of the meta-analysis showed that, compared with the control group, patients in the intervention group exhibited better performance in lymphedema management-related behaviors(SMD=2.65, 95%CI 1.53 to 3.78, P<0.01), symptoms related to lymphedema(SMD=-2.01, 95%CI-3.66 to-0.37, P<0.05), occurrence of lymphedema(RR=0.37, 95%CI 0.32 to 0.45, P<0.01), upper limb function(SMD=-1.88,95%CI-2.83 to-0.92, P<0.01), quality of life(SMD=2.79, 95%CI 2.05 to 3.54, P<0.01), and the difference was statistically significant. The intervention mainly included information support, material support, emotional support and decision support. Conclusion There are currently a variety of self-management interventions, but they mainly focus on information support. Self-management interventions can improve the self-management behavior of breast cancer patients with lymphedema and reduce the impact of lymphedema on patients.

关 键 词：乳腺癌 自我管理 系统评价 META分析 随机对照试验 淋巴水肿 

分 类 号：R473.73[医药卫生—护理学]