乳腺癌相关淋巴水肿患者中医护理的证据总结

doi:10.3761/j.issn.0254-1769.2023.17.006

摘要/Abstract

摘要：

目的检索、评价和总结乳腺癌相关淋巴水肿患者中医护理的最佳证据，为临床护理实践提供参考。方法按照“6S”模型检索相关文献，包括指南、专家共识、证据总结、临床决策、系统评价、Meta分析，检索时限为建库至2023年4月。由2名研究者对文献质量进行评价，并对证据进行提取、整合。结果共纳入13篇文献。其中3篇指南，3篇专家共识，3篇证据总结，4篇系统评价。从水肿病因及评估、中药外敷、中药熏洗、艾灸、穴位按摩、运动指导等6个方面汇总了16条最佳证据。结论中医护理是治疗乳腺癌相关淋巴水肿的有效方法，且无不良反应，但由于纳入文献的方法学质量不高，该结论需要高质量随机对照试验进一步证实。

关键词: 乳腺癌, 淋巴水肿, 中医护理学, 证据总结, 循证护理学

Abstract:

Objective To retrieve，evaluate and summarize the best-quality evidence on traditional Chinese medicine nursing for patients with breast cancer-related lymphedema. Methods According to the “6S” model，we used an evidence-based nursing method to retrieve relevant literature. The literature included guidelines，expert consensuses，evidence summaries，clinical decisions，systematic reviews，meta-analyses and original researches. Selected publications were from the earliest date in the database to April 30，2023. There were 2 researchers who evaluated the quality of literature and extracted and integrated evidence from the included articles. Results In total，13 publications were included，involving 3 sets of guidelines，3 expert consensuses，3 evidence summaries，4 systematic reviews. Ultimately，we summarized 16 pieces of the best-quality evidence on the etiology and evaluation of edema，external application of traditional Chinese medicine，traditional Chinese medicine fumigation and washing，moxibustion，acupressure point massage，traditional Chinese medicine diet nursing，and sports guidance. Conclusion Traditional Chinese medicine nursing is an effective treatment for patients with breast cancer-related lymphedema and does not have adverse reactions. However，as the quality of methodology in this study might be not too high，this conclusion may need to be further confirmed by high-quality randomized controlled trials.

Key words: Breast Cancer, Lymphedema, Traditional Chinese Medicine Nursing, Evidence Summary, Evidence-Based Nursing

周旭, 黄铮, 朱为康. 乳腺癌相关淋巴水肿患者中医护理的证据总结[J]. 中华护理杂志, 2023, 58(17): 2088-2094.

ZHOU Xu, HUANG Zheng, ZHU Weikang. Summary of the evidence on Traditional Chinese Medicine nursing for breast cancer-related lymphedema patients[J]. Chinese Journal of Nursing, 2023, 58(17): 2088-2094.

图/表 3

表1 纳入文献的一般特征（n=13）

Table 1 Characteristics of the included literature（n=13）

表2 指南的质量评价结果（n=3）

Table 2 Results of quality evaluation of the guidelines（n=3）

表3 乳腺癌相关淋巴水肿患者中医护理的证据总结

Table 3 Best evidence of Traditional Chinese Medicine nursing for breast cancer-related lymphedema

参考文献 35

[1]	李乐之, 路潜. 外科护理学[M]. 6版. 北京: 人民卫生出版社, 2020:11.
	Li LZ, Lu Q. Surgical nursing[M]. 6th ed. Beijing: People’s Medical Publishing House, 2020:11.
[2]	Leppäpuska IM, Hartiala P, Suominen S, et al. Phase 1 lymfactin? study:24-month efficacy and safety results of combined adenoviral VEGF-C and lymph node transfer treatment for upper extremity lymphedema[J]. J Plast Reconstr Aesthet Surg, 2022, 75(11):3938-3945. DOI PMID
[3]	DiSipio T, Rye S, Newman B, et al. Incidence of unilateral arm lymphoedema after breast cancer:a systematic review and meta-analysis[J]. Lancet Oncol, 2013, 14(6):500-515. DOI PMID
[4]	童静韬, 王颖, 倪平, 等. 乳腺癌患者术后肢体功能康复行为的质性研究[J]. 中华护理杂志, 2022, 57(6):711-717. DOI
	Tong JT, Wang Y, Ni P, et al. Rehabilitation behavior of limb function in postoperative breast cancer patients based on the theory of planned behavior:a qualitative research[J]. Chin J Nurs, 2022, 57(6):711-717.
[5]	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
[6]	Bao T, Iris Zhi W, Vertosick EA, et al. Acupuncture for breast cancer-related lymphedema:a randomized controlled trial[J]. Breast Cancer Res Treat, 2018, 170(1):77-87. DOI
[7]	Bu XF, Ng PH, Xu WJ, et al. The effectiveness of virtual reality-based interventions in rehabilitation management of breast cancer survivors:systematic review and meta-analysis[J]. JMIR Serious Games, 2022, 10(1):e31395. DOI URL
[8]	Martínez-Jaimez P, Fuster Linares P, Piller N, et al. Multidisciplinary preventive intervention for breast cancer-related lymphedema:an international consensus[J]. Eur J Cancer Care(Engl), 2022, 31(6):e13704.
[9]	蒋文婷, 陈丽君. 乳腺癌病人乳腺癌相关淋巴水肿发生风险及其与发病情况的关联效应分析[J]. 护理研究, 2022, 36(18):3338-3343.
	Jiang WT, Chen LJ. Risk of breast cancer-related lymphedema of patients with breast cancer and its correlation with incidence[J]. Chin Nurs Res, 2022, 36(18):3338-3343.
[10]	孙秋华. 中医护理学[M]. 5版. 北京: 人民卫生出版社, 2022:1-3.
	Sun QH. Traditional Chinese medicine nursing[M]. 5th ed. Beijing: People’s Medical Publishing House, 2022:1-3.
[11]	祝亚男, 俞国红, 杨方英, 等. 中医护理技术对减少乳腺癌患者术后并发症的效果研究[J]. 中华护理杂志, 2017, 52(3):289-292.
	Zhu YN, Yu GH, Yang FY, et al. Clinical research on Traditional Chinese Medicine nursing technology to decrease postoperative complication after breast cancer surgery[J]. Chin J Nurs, 2017, 52(3):289-292.
[12]	张宏如, 俞乔, 白子君, 等. 乳腺癌相关淋巴水肿发病机制及中医药干预研究进展[J]. 南京中医药大学学报, 2022, 38(3):258-264.
	Zhang HR, Yu Q, Bai ZJ, et al. Recent progress of the pathogenesis of breast cancer-related lymphedema and Chinese medicine intervention[J]. J Nanjing Univ Tradit Chin Med, 2022, 38(3):258-264.
[13]	刘璇璇, 李洁琼, 汤逸蘋, 等. 乳腺癌术后上肢淋巴水肿运动疗法干预研究范围综述[J]. 护理研究, 2023, 37(3):478-482.
	Liu XX, Li JQ, Tang YP, et al. Scoping review of exercise therapy intervention for upper limb lymphedema patients after breast cancer surgery[J]. Chin Nurs Res, 2023, 37(3):478-482.
[14]	Yoon JH, Kim EH, Park SB, et al. Impact of traditional East Asian medicine as an add-on therapy on survival and recurrence after surgery for breast cancer:a systematic review and meta-analysis[J]. Front Pharmacol, 2023, 14:1125373. DOI URL
[15]	冷福玉, 杨柱, 龙奉玺, 等. 温针灸治疗乳腺癌术后淋巴水肿现状[J]. 中医肿瘤学杂志, 2019, 1(4):63-66.
	Leng FY, Yang Z, Long FX, et al. Current situation of warming-needle moxibustion for postoperative lymphedema of breast cancer[J]. J Oncol Chin Med, 2019, 1(4):63-66.
[16]	杨志峥, 肖书超, 李璟. 黄芪桂枝五物汤合内消丸化裁外敷辅助中医外治手段治疗乳腺癌术后上肢淋巴水肿的疗效[J]. 肿瘤防治研究, 2020, 47(12):958-962.
	Yang ZZ, Xiao SC, Li J. Clinical effects of Huangqi Guizhi Wuwu Decoction and Neixiao pill cutting assisted with external treatment of Traditional Chinese Medicine on breast cancer patients with postoperative upper limb lymphedema[J]. Cancer Res Prev Treat, 2020, 47(12):958-962.
[17]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具——系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research:the quality evaluation of diagnostic and economic evaluation[J]. J Nurses Train, 2018, 33(8):701-703.
[18]	Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009, 12(4):99-101. DOI PMID
[19]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2021:52-103.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2021:52-103.
[20]	Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2:a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions,or both[J]. BMJ, 2017, 358:j4008.
[21]	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021年版)[J]. 中国癌症杂志, 2021, 31(10):954-1040.
	Breast Cancer Professional Committee of China Anti-Cancer Association. Guidelines and norms for diagnosis and treatment of breast cancer of China Anti-Cancer Association[J]. China Oncol, 2021, 31(10):954-1040.
[22]	国家中医药管理局医政司. 95个中医优势病种中医诊疗方案[EB/OL]. (2019-01-24)[2023-01-23]. https://www.cacm.org.cn/zhzyyxh/tzgg/lanmutzgg.shtml.
	Department of Medical Affairs,National Administration of Traditional Chinese Medicine. TCM diagnosis and treatment plan for 95 TCM dominant diseases[EB/OL]. (2019-01-24) [2023-01-23]. https://www.cacm.org.cn/zhzyyxh/tzgg/lanmutzgg.shtml.
[23]	Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment[J]. CA Cancer J Clin, 2017, 67(3):194-232. DOI URL
[24]	刘兆喆, 李秋华, 李文雅, 等. 乳腺癌术后淋巴水肿中西医结合诊治中国专家共识[J]. 创伤与急危重病医学, 2023, 11(1):1-8.
	Liu ZZ, Li QH, Li WY, et al. China expert consensus on diagnosis and treatment of lymphedema after breast cancer surgery with integrated traditional Chinese and western medicine[J]. Trauma Crit Care Med, 2023, 11(1):1-8.
[25]	中医优势病种诊疗方案和临床路径制定与实施项目组. 乳岩(乳腺癌巩固期)中医临床路径与诊疗方案[J]. 世界中西医结合杂志, 2022, 17(10):2101-2105.
	Working Group on the Formulation and Implementation of Treatment Schemes and Clinical Pathways for Dominant Diseases Treated by Traditional Chinese Medicine. Traditional Chinese Medicine clinical pathway and the diagnosis and treatment scheme of ruyan(breast cancer in the consolidation stage)[J]. World J Integr Tradit West Med, 2022, 17(10):2101-2105.
[26]	中国抗癌协会肿瘤营养专业委员会, 国家市场监管重点实验室肿瘤特医食品, 北京肿瘤学会肿瘤缓和医疗专业委员会, 等. 中国恶性肿瘤患者运动治疗专家共识[J]. 肿瘤代谢与营养电子杂志, 2022, 9(3):298-311.
	Chinese Society of Nutritional Oncology,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing Association of Oncology for Cancer Palliative Care, et al. Consensus of Chinese experts on exercise therapy for cancer patients[J]. Electron J Metab Nutr Cancer, 2022, 9(3):298-311.
[27]	李佳倩, 强万敏, 魏婷婷, 等. 乳腺癌相关淋巴水肿非药物干预的证据总结[J]. 中华护理杂志, 2023, 58(3):349-356. DOI
	Li JQ, Qiang WM, Wei TT, et al. Evidence summary for non-pharmacological interventions of breast cancer-related lymphedema[J]. Chin J Nurs, 2023, 58(3):349-356. DOI
[28]	史博慧, 吕爱莉, 王恋, 等. 乳腺癌术后上肢淋巴水肿预防策略的证据总结[J]. 护理学报, 2020, 27(22):32-38.
	Shi BH, Lü AL, Wang L, et al. Evidence summary of prevention strategies for upper limb lymphedema after breast cancer surgery[J]. J Nurs, 2020, 27(22):32-38.
[29]	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. DOI
	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. DOI
[30]	Wang SH, Zhang FX, Tang HQ, et al. The efficacy and safety of acupuncture and moxibustion for breast cancer lymphedema:a systematic review and network meta-analysis[J]. Gland Surg, 2023, 12(2):215-224. DOI URL
[31]	马丽芳, 刘玉芬, 卿雁冰, 等. 中药外敷治疗乳腺癌相关淋巴水肿的系统评价[J]. 中国实用护理杂志, 2022, 38(28):2234-2241.
	Ma LF, Liu YF, Qing YB, et al. External application of traditional Chinese medicine on treatment of breast cancer related lymphedema:a systematic review[J]. Chin J Prac Nurs, 2022, 38(28):2234-2241.
[32]	Gao Y, Ma TT, Han M, et al. Effects of acupuncture and moxibustion on breast cancer-related lymphedema:a systematic review and meta-analysis of randomized controlled trials[J]. Integr Cancer Ther, 2021, 20:15347354211044107. DOI PMID
[33]	王艺璇, 李惠萍, 江笑笑, 等. 乳腺癌术后淋巴水肿防治相关系统评价的再评价[J]. 中华肿瘤防治杂志, 2019, 26(8):588-594.
	Wang YX, Li HP, Jiang XX, et al. Overview of review on the prevention and treatment of breast cancer-related lymphedema[J]. Chin J Cancer Prev Treat, 2019, 26(8):588-594.
[34]	王丽丽, 田丽雅, 牛琪, 等. 11种运动对老年肌少症患者身体功能改善效果的网状Meta分析[J]. 中华护理杂志, 2022, 57(21):2652-2660.
	Wang LL, Tian LY, Niu Q, et al. The improvement effect of 11 kinds of exercise protocols on elderly patients with sarcopenia:a network meta analysis[J]. Chin J Nurs, 2022, 57(21):2652-2660.
[35]	武佩佩, 王盈, 沈傲梅, 等. 乳腺癌相关淋巴水肿患者综合消肿治疗依从性的质性研究[J]. 中华护理杂志, 2023, 58(7):781-787. DOI
	Wu PP, Wang Y, Shen AM, et al. Barriers and facilitators of adherence to complete decongestive therapy in patients with breast cancer related lymphedema:a theory-based qualitative study[J]. Chin J Nurs, 2023, 58(7):781-787.