乳腺癌相关淋巴水肿手法康复治疗的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.21.004

摘要/Abstract

摘要： 目的总结乳腺癌相关淋巴水肿手法康复治疗的最佳证据，旨在为临床护理实践提供循证依据。方法依据“6S”证据资源金字塔模型，系统检索UpToDate计算机决策支持系统、BMJ最佳临床实践、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、国际指南协作网、加拿大临床实践指南数据库、新西兰指南协作小组网站、苏格兰院际指南网、国际抗癌联盟网站、美国癌症协会网站、美国国家癌症研究所网站、美国物理治疗师协会网站、美国静脉和淋巴学会网站、美国淋巴水肿网站、伤口国际网站、加拿大安大略注册护士协会网站、医脉通、昆士兰卫生厅网站、中国知网、维普数据库、中国生物医学文献数据库、万方数据知识服务平台、Embase、Cochrane Library、PubMed、CHINAL、Web of Science、OVID电子期刊全文数据库中关于乳腺癌相关淋巴水肿手法康复治疗的证据，检索时限为建库至2023年1月，主要包括指南、共识、证据总结、临床决策、系统评价及原始研究。由2名研究者独立对文献进行质量评价和证据提取。结果该研究最终纳入19篇文献，其中包括4篇指南、4篇共识、1篇证据总结、3篇系统评价、1篇推荐实践、2篇临床决策、4篇原始研究。从手法康复的适应证、禁忌证、治疗要点、治疗效果、注意事项等5个方面总结了26条最佳证据。结论该研究总结了乳腺癌相关淋巴水肿手法康复治疗的相关证据，可为临床护理实践提供循证依据。在临床实践时，严格评估患者有无治疗禁忌证，治疗过程中遵循推荐的治疗方案并做好并发症的监测。

关键词: 乳腺肿瘤, 淋巴水肿, 手法康复, 手法淋巴引流, 证据总结

Abstract:

Objective To extract and summarize the best evidence of manual rehabilitation therapy in patients with breast cancer related lymphedema. It aims to provide evidence-based basis for clinical nursing staff intervention. Methods According to the “6S evidence resource pyramid model”，we systematically retrieved from UpToDate，BMJ best clinical practice，JBI evidence-based medicine center database of Joanna Briggs Institute in Australia，Embase，Cochrane Library，Pubmed，GIN，New Zealand Guidelines collaboration group，SIGN，American Cancer Society，American Association for Physical Therapy，American Society for Lymphatic，American Lymphedema Website，Ontario Association of Registered Nurses of Canada，Yimaitong，CNKI，VIP，CBM，WanFang，CHINAL，Web of Science and OVID databases from establishment of database to January 2023. It mainly includes guidelines，consensuses，evidence summaries，clinical decision-making，systematic evaluation and primitive research. There were 2 researchers who independently evaluated the quality of the literature and extracted evidence. Results A total of 19 pieces of the literature were involved，including 4 guidelines，4 consensuses，3 system reviews，1 recommended practice，2 clinical decision-making，1 summary of evidence，4 primitive research. Finally，26 pieces of best evidence are summarized from the 5 aspects of indications，contraindications，treatment points，treatment effects and precautions of manual rehabilitation. Conclusion This study summarized the evidence of manual rehabilitation therapy in breast cancer related lymphedema. It can provide practical basis for clinical nursing staff. In clinical practice，it is important to strictly evaluate whether patients have contraindications to treatment，to follow the recommended treatment plan and monitor complications during treatment.

Key words: Breast Neoplasms, Lymphedema, Manual Rehabilitation, Manual Lymphatic Drainage, Evidence Summary

邢乃芳, 王国蓉, 杨婧, ChaoHsing Yeh, 张甜, 田昌英, 陈思. 乳腺癌相关淋巴水肿手法康复治疗的最佳证据总结[J]. 中华护理杂志, 2023, 58(21): 2589-2597.

XING Naifang, WANG Guorong, YANG Jing, ChaoHsing Yeh, ZHANG Tian, TIAN Changying, CHEN Si. A summary of the best evidence for manual rehabilitation therapy in patients with breast cancer related lymphedema[J]. Chinese Journal of Nursing, 2023, 58(21): 2589-2597.

图/表 5

图1 PubMed检索策略

Figure 1 PubMed retrieval strategies

表1 纳入文献的基本情况（n=19）

Table 1 Basic information of included studies（n=19）

表2 纳入指南的方法学质量评价结果（n=4）

Table 2 Methodological quality evaluatio. Results of guidelines（n=4）

图2 文献筛选流程图

Figure 2 The flow diagram of literature screening

表3 乳腺癌相关淋巴水肿手法康复治疗的最佳证据总结

Table 3 Evidence summary of manual rehabilitation therapy in patients with breast cancer related lymphedema

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