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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2019, Vol. 13 ›› Issue (05) : 290 -295. doi: 10.3877/cma.j.issn.1674-0807.2019.05.007

所属专题： 文献；

论著

加速康复外科模式在乳腺癌术后早期患肢功能恢复中的应用
杨英1, 鲜继淑2, 周燕3, 齐小梅1,†()   
  1. 1. 400038　重庆，陆军军医大学西南医院乳腺甲状腺外科
    2. 400038　重庆，陆军军医大学西南医院神经外科
    3. 400038　重庆，陆军军医大学西南医院医务处
  • 收稿日期:2019-07-15 出版日期:2019-10-01
  • 通信作者: 齐小梅
  • 基金资助:
    陆军军医大学西南医院护理创新课题资助项目(SWHLKJ-B04)

Application of fast track surgery in early functional recovery of affected limbs after breast cancer surgery

Ying Yang1, Jishu Xian2, Yan Zhou3, Xiaomei Qi1,†()   

  1. 1. Department of Breast and Thyroid Surgery, Southwest Hospital, Army Medical University, Chongqing 400038, China
    2. Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing 400038, China
    3. Department of Medical Affairs, Southwest Hospital, Army Medical University, Chongqing 400038, China
  • Received:2019-07-15 Published:2019-10-01
  • Corresponding author: Xiaomei Qi
  • About author:
    Corresponding author: Qi Xiaomei, Email:
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引用本文：

杨英, 鲜继淑, 周燕, 齐小梅. 加速康复外科模式在乳腺癌术后早期患肢功能恢复中的应用[J]. 中华乳腺病杂志(电子版), 2019, 13(05): 290-295.

Ying Yang, Jishu Xian, Yan Zhou, Xiaomei Qi. Application of fast track surgery in early functional recovery of affected limbs after breast cancer surgery[J]. Chinese Journal of Breast Disease(Electronic Edition), 2019, 13(05): 290-295.

目的

探讨加速康复外科模式在乳腺癌术后早期患肢功能恢复中的应用。

方法

按照纳入及排除标准，选取2016年5月至2017年5月陆军军医大学西南医院医院收治的乳腺癌患者124例进行前瞻性研究，采用随机数字表法分为对照组和干预组，每组62例。对照组采用常规护理方法对患者进行患肢功能锻炼指导；干预组采用加速康复外科模式对患者进行术前宣教，术后由专人指导患肢功能锻炼，出院后由护理专家门诊评估并制定个体化锻炼方案及建立微信平台指导和督促。用t检验比较2组患者术后伤口恢复时间、引流时间以及住院时间的差异。在术后10 d、1个月及3个月，采用Constant-Murley肩功能测定标准评估患肢功能恢复情况，应用WHOQOL-BREF生活质量评定量表评估患者生活质量，并采用重复测量数据方差分析比较2组评分。

结果

干预组的术后伤口恢复时间、引流时间以及住院时间分别为(7.5±2.1) d、(6.3±2.4) d及(7.6±2.4) d，明显低于对照组的(10.3±3.2) d、(10.2±3.7) d及(10.2±4.2) d(t＝5.762、6.963、4.232，P均<0.001)。干预组患者的术后患肢功能恢复情况评分优于对照组(疼痛：组间比较，F＝94.553，P<0.001；时间点比较，F＝723.882，P<0.001；交互作用，F＝21.356，P＝0.169；日常行为能力：组间比较，F＝351.725，P<0.001；时间点比较，F＝1 681.920，P<0.001；交互作用，F＝20.623，P<0.001；关节活动度：组间比较，F＝441.381，P<0.001，时间点比较，F＝2 458.887，P<0.001；交互作用，F＝28.420，P<0.001;肌力：组间比较，F＝84.571，P<0.001；时间点比较，F＝1 474.775，P<0.001；交互作用，F＝13.862，P<0.001)。干预组患者的术后生活质量评分也优于对照组(生活质量主观感觉：组间比较，F＝235.607，P<0.001；时间点比较，F＝607.245，P<0.001；交互作用，F＝1.913，P＝0.169；健康状况主观感觉：组间比较，F＝140.170，P<0.001；时间点比较，F＝618.834，P<0.001，交互作用，F＝1.533，P＝0.218；生理健康：组间比较，F＝72.713，P<0.001，时间点比较，F＝2 324.181，P<0.001；交互作用，F＝18.296，P<0.001;心理健康：组间比较，F＝64.987，P<0.001；时间点比较，F＝2 613.833，P<0.001，交互作用，F＝16.158，P<0.001；社会关系：组间比较，F＝58.654，P<0.001；时间点比较，F＝2 775.791，P<0.001；交互作用，F＝16.710，P<0.001；环境：组间比较，F＝59.818，P<0.001；时间点比较，F＝2 638.321，P<0.001；交互作用，F＝22.660，P<0.001)。

结论

加速康复外科模式对乳腺癌患者术后进行患肢功能锻炼的干预可以显著提高患者功能锻炼的依从性，提高患者的生活质量。

关键词: 乳腺肿瘤, 康复护理, 功能恢复, 上肢
Objective

To investigate the application of fast track surgery in early functional recovery of affected limbs after breast cancer surgery.

Methods

According to the inclusion and exclusion criteria, 124 patients with breast cancer in the Southwest Hospital, Army Medical University from May 2016 to May 2017 were enrolled for a prospective study. The patients were divided into control group and intervention group by random number table, 62 cases in each group. In control group, conventional nursing methods were used for functional exercises of limbs. In intervention group, fast-track surgery was applied, i. e., preoperative and postoperative guidance on functional exercises of the affected limbs was given; after discharge, clinical nursing specialists made an individualized exercise program for each patient after evaluation in clinic and provided guidance and supervision by WeChat. The postoperative wound recovery time, duration of drainage and length of hospital stay were compared between two groups by t test. At postoperative 10 days, 1 and 3 months, the Constant-Murley shoulder assessment was used to evaluate the functional recovery of the affected limbs and the WHOQOL-BREF quality of life assessment was used to evaluate the quality of life of breast cancer patients. The scores were compared between two groups using repeated measures analysis of variance.

Results

The recovery time of wound, duration of drainage and length of hospital stay were (7.5±2.1) d, (6.3±2.4) d and(7.6±2.4) d in intervention group, which were significantly lower than those in control group[(10.3±3.2) d, (10.2±3.7) d, (10.2±4.2) d; t=5.762, 6.963, 4.232, all P<0.001). The scores on postoperative limb function recovery in intervention group were superior to those in control group (pain: comparison between groups, F=94.553, P<0.001; time point comparison, F=723.882, P<0.001; interaction, F=21.356, P=0.169; daily mobility: comparison between groups, F=351.725, P<0.001; time point comparison, F=1 681.920, P<0.001; interaction, F=20.623, P<0.001; range of motion of the joints: comparison between groups, F=441.381, P<0.001; time point comparison, F=2 458.887, P<0.001; interaction, F=28.420, P<0.001; muscle strength: comparison between groups, F=84.571, P<0.001; time point comparison, F=1 474.775, P<0.001; interaction, F=13.862, P<0.001). The scores on postoperative quality of life in intervention group were also significantly better than those in control group (subjective feeling on quality of life: comparison between groups, F=235.607, P<0.001; time point comparison, F=607.245, P<0.001; interaction, F=1.913 P=0.169; subjective feeling on health status: comparison between groups, F=140.170, P<0.001; time point comparison, F=618.834, P<0.001; interaction, F=1.533, P=0.218; physical health: comparison between groups, F=72.713, P<0.001; time point comparison, F=2 324.181, P<0.001; interaction, F=18.296, P<0.001; mental health: comparison between groups, F=64.987, P<0.001; time point comparison, F=2 613.833, P<0.001; interaction, F=16.158, P<0.001; social relationship: comparison between groups, F=58.654, P<0.001; time point comparison, F=2 775.791, P<0.001; interaction F=16.710, P<0.001; environment: comparison between groups, F=59.818, P<0.001; time point comparison, F=2 638.321, P<0.001; interaction, F=22.660, P<0.001).

Conclusion

The mode of fast track surgery can significantly improve early functional exercises of affected limbs in breast cancer patients after surgery, increase their compliance and ameliorate their quality of life.

Key words: Breast neoplasms, Rehabilitation nursing, Recovery of function, Upper extremity
表1 2组乳腺癌患者的基线资料比较(例)
指标 干预组(n＝62) 对照组(n＝62) 检验值 P值
体质指数a ? ? ? ?
? ≤18.5 kg/m2 1 2 ? ?
　 18.6～23.9 kg/m2 31 27 ? ?
　 24.0～27.9 kg/m2 24 28 ? ?
　 ≥28.0 kg/m2 6 5 0.284 0.777
病理诊断b ? ? ? ?
? 非浸润性癌 3 2 ? ?
? 浸润性非特殊类型癌 57 59 ? ?
? 浸润性特殊类型癌 2 1 0.711 0.758
肿瘤部位b ? ? ? ?
? 外上象限 30 29 ? ?
? 内下象限 4 12 ? ?
? 乳晕区 0 1 ? ?
? 内上象限 25 15 ? ?
? 外下象限 3 5 7.884 0.069
临床分期a ? ? ? ?
? Ⅰ期 9 5 ? ?
? Ⅱ期 39 36 ? ?
? Ⅲ期 13 18 ? ?
? Ⅳ期 1 3 1.672 0.095
手术切口b ? ? ? ?
? 横切口 52 45 ? ?
? 纵切口 2 1 ? ?
? 斜切口 8 16 3.538 0.172
腋窝淋巴结清扫a ? ? ? ?
? Ⅰ水平 36 27 ? ?
? Ⅱ水平 16 22 ? ?
? Ⅲ水平 10 13 1.494 0.135
表2 2组乳腺癌患者术后伤口恢复相关指标比较(d，±s)
组别 例数 伤口恢复时间 引流时间 住院时间
干预组 62 7.5±2.1 6.3±2.4 7.6±2.4
对照组 62 10.3±3.2 10.2±3.7 10.2±4.2
t值 ? 5.762 6.963 4.232
P值 ? <0.001 <0.001 <0.001
表3 2组乳腺癌患者术后患肢功能恢复评分比较(±s，分)
组别 例数 术后
10 d 1个月 3个月
? ? 疼痛a(15分)
干预组 62 7.0±2.9 12.7±2.5 15.0±0.0
对照组 62 3.0±2.6 8.5±2.9 13.6±2.2
t值 ? 8.063 8.698 4.800
P值 ? <0.001 <0.001 <0.001
? ? 日常行为能力b(20分)
干预组 62 9.3±1.6 13.0±1.3 18.7±1.3
对照组 62 5.2±1.4 10.2±1.6 14.0±1.9
t值 ? 15.536 10.484 16.200
P值 ? <0.001 <0.001 <0.001
? ? 关节活动度c(40分)
干预组 62 13.8±3.8 28.9±2.5 37.7±1.8
对照组 62 4.3±2.2 15.4±4.8 29.1±5.0
t值 ? 16.974 19.625 12.798
P值 ? <0.001 <0.001 <0.001
? ? 肌力d(25分)
干预组 62 11.4±3.4 20.2±3.1 24.6±1.4
对照组 62 7.1±2.6 15.2±3.4 22.3±2.7
t值 ? 7.799 8.328 5.917
P值 ? <0.001 <0.001 <0.001
表4 2组患者生活质量评分比较(±s，分)
组别 例数 术后
10 d 1个月 3个月
? ? 生活质量主观感觉a(5分)
干预组 62 2.6±0.5 3.6±0.7 4.4±0.6
对照组 62 1.4±0.5 2.4±0.6 3.1±0.5
? ? 健康状况主观感觉b(5分)
干预组 62 2.7±0.6 3.7±0.6 4.5±0.5
对照组 62 1.8±0.4 2.8±0.5 3.4±0.6
? ? 生理健康c(20分)
干预组 62 4.4±0.8 9.5±1.4 15.0±1.9
对照组 62 3.6±1.0 8.3±0.9 12.5±1.6
t值 ? 4.780 5.553 7.670
P值 ? <0.001 <0.001 <0.001
? ? 心理健康d(20分)
干预组 62 4.3±0.9 10.0±1.4 15.6±1.8
对照组 62 3.7±1.0 8.6±1.1 13.4±1.6
t值 ? 3.206 6.256 7.234
P值 ? 0.002 <0.001 <0.001
? ? 社会关系e(20分)
干预组 62 4.4±1.1 10.4±1.5 15.6±1.8
对照组 62 3.7±1.1 8.9±1.4 13.3±1.6
t值 ? 3.669 5.831 7.670
P值 ? <0.001 <0.001 <0.001
? ? 环境f(20分)
干预组 62 4.5±1.0 10.5±1.5 16.2±1.7
对照组 62 3.8±1.3 9.0±1.5 13.6±1.7
t值 ? 3.039 5.479 8.558
P值 ? 0.003 <0.001 <0.001
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