乳腺癌术后淋巴水肿预防与护理的循证实践

doi:10.3761/j.issn.0254-1769.2023.07.001

摘要/Abstract

摘要：

目的运用知识转化理论开展乳腺癌术后淋巴水肿预防与护理的循证实践，并探讨效果。方法通过寻找证据、将证据引入临床情景、制订循证方案、基线审查、评估分析促进与障碍因素，于2021年8月—2022年6月将“乳腺癌术后淋巴水肿预防和护理”团体标准（以下简称“团体标准”）应用于临床，比较“团体标准”应用前后医护人员乳腺癌淋巴水肿预防及护理知识技能得分、乳腺癌患者淋巴水肿自我护理行为得分、医护人员与患者对审查指标的执行率。结果循证实践实施后，医护人员乳腺癌淋巴水肿预防与护理知识技能得分显著高于实施前，差异具有统计学意义（t=4.074，P<0.001）；乳腺癌患者淋巴水肿自我护理行为得分显著高于实施前，差异有统计学意义（t=11.459，P<0.001）。审查指标的执行率由33.33%~100%上升77.14%~100%，15项审查指标的执行率差异有统计学意义（P<0.05）。结论将“团体标准”应用于临床，能够促进相关制度规范的完善，提高医护人员相关知识技能，改善乳腺癌患者淋巴水肿预防意识及行为能力。

关键词: 乳腺肿瘤, 淋巴水肿, 预防, 循证护理学

Abstract:

Objective Evidence-based practice of lymphedema prevention and nursing after breast cancer surgery was carried out with knowledge transformation theory，and its application effect was discussed. Methods The group standard “Prevention and Care of Lymphedema after Breast Cancer Surgery” was applied into clinical practice from August 2021 to June 2022 by searching for evidence，introducing evidence into clinical scenarios，developing evidence-based protocols，baseline review，evaluating and analyzing the promoting and obstructive factors. The prevention and nursing knowledge and skills of breast cancer lymphedema among medical staff and lymphedema prevention behavior scores of breast cancer patients before and after the application of the Group Standard were compared and the implementation rate of the review items were compared. Results After the implementation of the evidence-based practice，the knowledge and skills of medical staff was significantly higher than that before the implementation，and the difference was statistically significant（t=4.074，P<0.001）. The self-care behavioral ability of lymphedema in breast cancer patients was significantly higher than before，with statistical significance（t=11.459，P<0.001）. The implementation rate of the examined items increased from 33.33%~100% to 77.14%~100%. Conclusion The Group Standard should be applied to clinical practice，which can promote the improvement of relevant systems and norms，improve the knowledge and skills of medical staff，and improve the prevention awareness and behavioral ability of breast cancer patients with lymphedema.

Key words: Breast Neoplasm, Lymphedema, Prevention, Evidence-Based Nursing

郭员志, 张红梅, 赵培, 王琦, 李玉环, 王淑芬, 于洋. 乳腺癌术后淋巴水肿预防与护理的循证实践[J]. 中华护理杂志, 2023, 58(7): 773-780.

GUO Yuanzhi, ZHANG Hongmei, ZHAO Pei, WANG Qi, LI Yuhuan, WANG Shufen, YU Yang. Evidence-based practice of lymphedema prevention and nursing care after breast cancer surgery[J]. Chinese Journal of Nursing, 2023, 58(7): 773-780.

图/表 4

表1 临床审查指标及审查方法

Table 1 Clinical review methods

表2 “团体标准”执行障碍和促进因素分析

Table 2 Analysis of obstacles and contributing factors to the implementation of Group Standard

表3 两组患者一般资料比较（n=45）

Table 3 Comparison of general data of patients（n=45）

表4 实施“团体标准”前后审查指标执行率的比较

Table 4 Comparison of implementation rate of review indicators before and after Group Standard application

参考文献 22

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality world-wide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249. DOI URL
[2]	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
[3]	Zhang X, Tang B, Zou D, et al. Discussion of relationships among changes of pathological indicators,postoperative lymphedema of the upper limb,and prognosis of patients with breast cancer[J]. Biosci Rep, 2019, 39(4):1-11.
[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 randomized controlled clinical trial[J]. Qual Life Res, 2020, 29(7):1789-1800. DOI
[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]	International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema:2020 consensus document of the International Society of Lymphology[J]. Lymphology, 2020, 53(1):3-19.
[8]	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 randomized controlled clinical trial[J]. Qual Life Res, 2020, 29(7):1789-1800. DOI
[9]	赵慧慧. 基于JBI循证模式的乳腺癌淋巴水肿管理证据转化研究[D]. 广州: 南方医科大学, 2021.
	Zhao HH. Clinical translation of the management program of patients with breast cancer-related lymphedema based on JBI model[D]. Guangzhou: Southern Medical University, 2021.
[10]	刘飞, 司龙妹, 王影新, 等. 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. DOI
	Liu F, Si LM, Wang YX, et al. Evidence summary of resistance training for breast cancer-related lymphedema[J]. Chin J Nurs, 2021, 56(5):755-761. DOI
[11]	韦小夏, 符鑫, 沈傲梅, 等. 乳腺癌患者淋巴水肿自我管理的证据总结[J]. 中华护理杂志, 2022, 57(2):237-244. DOI
	Wei XX, Fu X, Shen AM, et al. Evidence summary for self-management of lymphedema in breast cancer patients[J]. Chin J Nurs, 2022, 57(2):237-244. DOI
[12]	Rycroft-Malone J, Bucknall T. Models and frameworks for implementing evidence-based practice:linking evidence to action[M]. Chichester,West Sussex: John Wiley & Sons Ltd, 2010:82-102.
[13]	中华护理学会. 乳腺癌术后淋巴水肿预防和护理[EB/OL].(2021-03-13) [2021-05-31]. http://www.zhhlxh.org.cn/cnaWebcn/article/3245.
	Chinese Nursing Association. Prevention and nursing of lymphedema after breast cancer surgery[EB/OL]. (2021-03-13) [2021-05-31]. http://www.zhhlxh.org.cn/cnaWebcn/article/3245.
[14]	Pearson A, Wiechula R, Court A, et al. The JBI model of evidence-based healthcare[J]. Int J Evid Based Healthc, 2005, 3(8):207-215.
[15]	Deveci ZO, Bilik O. Development of the Breast Cancer Related Lymphedema Self-care Scale[J]. Clin Nurs Res, 2020, 8:1-12.
[16]	尤渺宁, 万巧琴, 吕治华, 等. 乳腺癌相关淋巴水肿患者自我护理行为现状及影响因素研究[J]. 护理管理杂志, 2022, 22(9):648-654.
	You MN, Wan QQ, Lü ZH, et al. The status and influencing factors of self-care behavior in patients with breast cancer related lymphedema[J]. J Nurs Adm, 2022, 22(9):648-654.
[17]	徐元元, 史广玲, 张燕红, 等. 预防ICU患者大便失禁性皮炎的循证实践[J]. 中华护理杂志, 2021, 56(6):811-817. DOI
	Xu YY, Shi GL, Zhang YH, et al. Evidence-based practice in prevention of fecal incontinence associated dermatitis in ICU patients[J]. Chin J Nurs, 2021, 56(6):811-817. DOI
[18]	李加敏, 庞冬, 路潜, 等. 尿路造口周围刺激性皮炎患者的循证护理实践[J]. 中华护理杂志, 2020, 55(11):1624-1629. DOI
	Li JM, Pang D, Lu Q, et al. Evidence-based nursing practice of peristomal irritant dermatitis in patients with urostomies[J]. Chin J Nurs, 2020, 55(11):1624-1629. DOI
[19]	陈凌华, 林文璇, 颜斐斐, 等. 基于KTA知识转化模式的择期支气管镜检查患儿术前管理循证实践[J]. 护理学杂志, 2021, 36(18):91-94.
	Chen LH, Lin WX, Yan FF, et al. Evidence based practice of preoperative management in children undergoing selective bronchoscopy based on knowledge-to-action framework[J]. J Nurs Sci, 2021, 36(18):91-94.
[20]	程湘玮, 王培红, 屠凤鸣, 等. 妊娠期糖尿病产妇分娩的新生儿血糖管理审查指标的制订及障碍因素分析[J]. 中华护理杂志, 2020, 55(10):1497-1502. DOI
	Cheng XW, Wang PH, Tu FM, et al. Establishment and obstacle analysis of evidence-based nursing indexes of blood glucose management in neonates delivered by mothers with gestational diabetes[J]. Chin J Nurs, 2020, 55(10):1497-1502. DOI
[21]	Abu Sharour L. Oncology nurses’ knowledge about lymphedema assessment,prevention,and management among women with breast cancer[J]. Breast Disease, 2019, 38(3/4):103-108. DOI URL
[22]	尤渺宁, 万巧琴. 乳腺癌相关淋巴水肿患者自我护理的研究进展[J]. 中华护理杂志, 2021, 56(3):464-468. DOI
	You MN, Wan QQ. Research progress of self-care in patients with breast cancer-related lymphedema[J]. Chin J Nurs, 2021, 56(3):464-468. DOI