乳腺癌相关淋巴水肿患者抗阻力训练的证据总结

doi:10.3761/j.issn.0254-1769.2021.05.020

摘要/Abstract

摘要：

目的检索、评价和汇总乳腺癌相关淋巴水肿患者抗阻力训练的最佳证据,为临床开展乳腺癌相关淋巴水肿抗阻力训练干预提供循证依据。方法检索BMJ Best Practice、UpToDate、加拿大安大略护士学会网站、美国国家综合癌症网络、英国国立健康与临床优化研究所、苏格兰学院指南网、医脉通、PubMed、CINAHL、Cochrane Library、Joanna Briggs Institute COnNECT+、中国知网、万方数据平台、国际淋巴水肿网站、国际淋巴水肿协会网站内关于乳腺癌相关淋巴水肿患者抗阻力训练的所有证据,包括指南、证据总结、临床决策、最佳实践信息册、系统评价、专家共识,检索时限为建库至2020年9月1日。由2名研究者对文献质量进行评价和资料提取。结果共纳入21篇文献,其中1篇指南,14篇系统评价,2篇专家共识,1篇最佳实践信息册,3篇证据总结。从禁忌证、开始时间、训练形式、训练强度、训练效果、注意事项6个方面,共提取23条最佳证据。结论结合个体化锻炼、专业人员指导、定期监测管理的抗阻力训练,对乳腺癌相关淋巴水肿患者是安全且有益的。医护人员应结合临床特点和工作环境,同时考虑患者的个体情况及锻炼条件,为患者制订个性化的抗阻力训练方案,从而确保训练依从性、安全性和有效性。

关键词: 乳腺肿瘤, 淋巴水肿, 抗阻力训练, 循证护理学

Abstract:

Objective To retrieve,evaluate and summarize the best evidence of resistance training for breast cancer-related lymphedema.Methods We searched BMJ Best Practice,UpToDate,Registered Nurses’ Association of Ontario（RNAO）,National Comprehensive Cancer Network（NCCN）,National Institute for Health and Clinical Excel-lence（NICE）,Scottish Intercollegiate Guidelines Network（SIGN）,Medive,PubMed,CINAHL,Cochrane library,Joanna Briggs Institute（JBI） COnNECT+,CNKI,Wanfang,National Lymphedema Network（NLN）,International Society of Lymphology（ISL） to collect relevant guidelines,evidence summaries,recommended practice,systematic reviews and expert consensuses published from database construction to September 1st of 2020. 2 researchers evaluated the quality of various literature,and extracted recommendations and research conclusions from the included literature.Results Totally 21 articles were involved,including 1 guideline,14 systematic reviews,2 expert consensuses,1 recommended practice and 3 evidence summaries. Finally,23 pieces of best evidence about contraindications,timing of training,training forms,training intensity and training effectiveness were summarized.Conclusion Resistance training combined with individualized exercises,professional guidance and regular monitoring management is safe and beneficial. Clinical staff should develop resistance training program based on clinical environment as well as patient’s individual situation and training conditions.

Key words: Breast Neoplasm, Lymphedema, Resistance Training, Evidence-Based Nursing

刘飞,司龙妹,王影新,王悦,张树琪,丁炎明,李晶,谷洪涛. 乳腺癌相关淋巴水肿患者抗阻力训练的证据总结[J]. 中华护理杂志, 2021, 56(5): 755-761.

LIU Fei,SI Longmei,WANG Yingxin,WANG Yue,ZHANG Shuqi,DING Yanming,LI Jing,GU Hongtao. Evidence summary of resistance training for breast cancer-related lymphedema[J]. Chinese Journal of Nursing, 2021, 56(5): 755-761.

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参考文献 33

[1]	Zou L, Liu FH, Shen PP, et al. The incidence and risk factors of related lymphedema for breast cancer survivors post-operation:a 2-year follow-up prospective cohort study[J]. Breast Cancer, 2018,25(3):309-314. DOI PMID
[2]	Huang H, Zhou J, Zeng Q. Risk factors associated with lymphedema among postmenopausal breast cancer survivors after radical mastectomy and axillary dissection in china[J]. Breast Care(Basel), 2012,7(6):461-464.
[3]	Ribeiro Pereira ACP, Koifman RJ, Bergmann A. Incidence and risk factors of lymphedema after breast cancer treatment:10 years of follow-up[J]. Breast, 2017,36:67-73. DOI URL
[4]	刘飞, 路潜, 欧阳倩, 等. 乳腺癌患者术后淋巴水肿与其相关症状的关系研究[J]. 中华护理杂志, 2016,51(5):518-522.
	Liu F, Lu Q, Ouyang Q, et al. The relationship between lymphedema status and lymphedema symptoms in breast cancer survivors[J]. Chin J Nurs, 2016,51(5):518-522.
[5]	Omidi Z, Kheirkhah M, Abolghasemi J, et al. Effect of lymphedema self-management group-based education compared with social network-based education on quality of life and fear of cancer recurrence in women with breast cancer:a rando-mized controlled clinical trial[J]. Qual Life Res, 2020,29(7):1789-1800. DOI URL
[6]	International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema:2020 consensus document of the international society of lymphology[J]. Lymphology, 2020,53(2020):3-19.
[7]	Fu MR, Axelrod D, Guth AA, et al. Usability and feasibility of health IT interventions to enhance self-care for lymphedema symptom management in breast cancer survivors[J]. Internet Interv, 2016,5:56-64. DOI URL
[8]	Reid AM, Arin KG. Lymphoedema(2018-04-01)[2020-09-01]. https://bestpractice.bmj.com/topics/en-gb/610?q=Lymphoedema&c=recentlyviewed.
[9]	Kwan ML, Cohn JC, Armer JM, et al. Exercise in patients with lymphedema:a systematic review of the contemporary literature[J]. J Cancer Surviv, 2011,5(4):320-336. DOI URL
[10]	Paramanandam VS, Roberts D. Weight training is not harmful for women with breast cancer-related lymphoedema:a systematic review[J]. J Physiother, 2014,60(3):136-143. DOI PMID
[11]	Cheema BS, Kilbreath SL, Fahey PP, et al. Safety and efficacy of progressive resistance training in breast cancer:a systematic review and meta-analysis[J]. Breast Cancer Res Treat, 2014,148(2):249-268. DOI URL
[12]	Davies C, Levenhagen K, Ryans K, et al. Interventions for breast cancer-related lymphedema:clinical practice guideline from the academy of oncologic physical therapy of APTA[J]. Phys Ther, 2020,100(7):1163-1179. DOI URL
[13]	Ammitzbøll G, Johansen C, Lanng C, et al. Progressive resistance training to prevent arm lymphedema in the first year after breast cancer surgery:results of a randomized controlled trial[J]. Cancer, 2019,125(10):1683-1692. DOI PMID
[14]	Cheema B, Gaul CA, Lane K, et al. Progressive resistance training in breast cancer:a systematic review of clinical trials[J]. Breast Cancer Res Treat, 2008,109(1):9-26. DOI URL
[15]	Brouwers MC, Kho ME, Browman GP, et al. Agree Ⅱ:advancing guideline development,reporting,and evaluation in health care[J]. Prev Med, 2010,51(5):421-424. DOI PMID
[16]	The Joanna Briggs Institute. The Joanna Briggs Institute Reviews’ Manual: 2016 edition[EB/OL]. [2019-10-10]. https://www.joannabriggs.org.
[17]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015,30(11):964-967.
	Wang CQ, Hu Y. The Joanna Briggs Institute pre-classification and evidence rank system(2014 edition)[J]. J Nurs Train, 2015,30(11):964-967.
[18]	McLaughlin SA, Staley AC, Vicini F, et al. Considerations for clinicians in the diagnosis,prevention,and treatment of breast cancer-related lymphedema:recommendations from a multidisciplinary expert asbrs panel:Part 1:definitions,assessments,education,and future directions[J]. Ann Surg Oncol, 2017,24(10):2818-2826. DOI URL
[19]	Chan DN, Lui LY, So WK. Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer:systematic review[J]. J Adv Nurs, 2010,66(9):1902-1914.
[20]	Stuiver MM, ten Tusscher MR, Agasi-Idenburg CS, et al. Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy[J]. Cochrane Database Syst Rev, 2015(2):CD009765.
[21]	文翠菊, 李晓婷, 于新颖. 不同康复锻炼对术后乳腺癌患者康复结局影响的meta分析[J]. 中国实用护理杂志, 2015,31(10):762-768.
	Wen CJ, Li XT, Yu XY. Different exercise programs on the rehabilitation of the postoperative breast cancer patients:a meta-analysis[J]. Chin J Prac Nurs, 2015,31(10):762-768.
[22]	Nelson NL. Breast cancer-related lymphedema and resistance exercise:a systematic review[J]. J Strength Cond Res, 2016,30(9):2656-2665. DOI URL
[23]	Singh B, Disipio T, Peake J, et al. Systematic review and meta-analysis of the effects of exercise for those with cancer-related lymphedema[J]. Arch Phys Med Rehabil, 2016,97(2):302-315. DOI PMID
[24]	李呈, 孟爱凤, 程芳, 等. 抗阻运动对乳腺癌术后患者上肢淋巴水肿和肌肉力量影响的系统评价[J]. 护理学杂志, 2018,33(9):97-101.
	Li C, Meng AF, Cheng F, et al. A systematic review on effect of resistance exercise on upper limb lymphedema and muscle strength in postoperative breast cancer patients[J]. J Nurs Sci, 2018,33(9):97-101.
[25]	Baumann FT, Reike A, Hallek M, et al. Does exercise have a preventive effect on secondary lymphedema in breast cancer patients following local treatment? A systematic review[J]. Breast Care(Basel), 2018,13(5):380-385.
[26]	Baumann FT, Reike A, Reimer V, et al. Effects of physical exercise on breast cancer-related secondary lymphedema:a systematic review[J]. Breast Cancer Res Treat, 2018,170(1):1-13. DOI URL
[27]	Wanchai A, Armer JM. Effects of weight-lifting or resistance exercise on breast cancer-related lymphedema:a systematic review[J]. Int J Nurs Sci, 2019,6(1):92-98.
[28]	Hasenoehrl T, Palma S, Ramazanova D, et al. Resistance exercise and breast cancer-related lymphedema-a systematic review update and meta-analysis[J]. Support Care Cancer, 2020,28(8):3593-3603. DOI PMID
[29]	Susan S, Grad DM. Lymphedema（breast cancer）：resistance trai-ning[EB/OL]. (2019-02-01)[2020-09-01]. http://connect.jbicon-nectplus.org/ViewDocument.aspx?0=21469.
[30]	Ashley W. Breast cancer exercise prescription[EB/OL]. (2019-04-01)[2020-09-01]. http://connect.jbiconnectplus.org/View-Document.aspx?0=21101.
[31]	赵慧慧, 周春兰, 吴艳妮, 等. 乳腺癌相关淋巴水肿患者运动指导方案的证据总结[J]. 中华护理杂志, 2020,55(5):779-785.
	Zhao HH, Zhou CL, Wu YN, et al. Evidence summary of exercise programs on patients with breast cancer-related lymphedema[J]. Chin J Nurs, 2020,55(5):779-785.
[32]	Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy:a multicenter randomized controlled trial[J]. J Clin Oncol, 2007,25(28):4396-4404. DOI URL
[33]	钟婕, 周英凤. 知识转化模式在护理实践中的应用进展[J]. 中华护理杂志, 2017,52(11):1366-1370.
	Zhong J, Zhou YF. Implementation of knowledge to action framework in nursing practice:a review[J]. Chin J Nurs, 2017,52(11):1366-1370.