抗阻训练改善乳腺癌术后患者淋巴水肿的效果评价

doi:10.3761/j.issn.0254-1769.2025.02.009

摘要/Abstract

摘要：

目的构建乳腺癌相关淋巴水肿抗阻训练方案并验证其可行性和有效性，旨在为乳腺癌术后患者康复锻炼提供借鉴。方法根据淋巴回流动力源中的肌肉收缩和胸腔负压2个可干预因素，结合乳腺癌相关淋巴水肿患者抗阻训练的最佳证据，制订乳腺癌相关淋巴水肿患者抗阻训练方案初稿。通过2轮专家论证和预试验对方案进行修订和可行性分析。采用便利抽样法，选取2022年1月—5月在合肥市某三级甲等医院的34例乳腺癌相关淋巴水肿患者作为试验组，2022年9月—2023年1月在芜湖市某三级甲等医院的34例乳腺癌相关淋巴水肿患者作为对照组。试验组和对照组都进行为期12周的综合消肿疗法（手法淋巴引流、穿戴压力衣和皮肤护理），试验组在此基础上进行为期12周的抗阻训练。收集干预前和干预后第2、4、8、12周两组患侧上肢的握力、患侧上肢细胞外液量与细胞内液量比值、第1秒用力呼气容积。结果乳腺癌相关淋巴水肿患者抗阻训练方案包括抗阻呼吸训练、抗阻肌肉训练、热身训练、放松训练4个部分。专家的权威系数为0.89，第1轮专家论证的肯德尔和谐系数为0.42，变异系数为0.08~0.27。第2轮专家论证的肯德尔和谐系数为0.67，变异系数为0~0.19。预试验结果显示，5例患者训练完成度为62.50%~100%，训练过程中无不良事件发生。试验组31例、对照组30例完成了12周的干预。重复测量方差分析显示，试验组的患侧上肢握力、第1秒用力呼气容积的增加幅度大于对照组（P<0.05），试验组的患侧上肢细胞外液量与细胞内液量比值的下降幅度大于对照组（P<0.05）。结论该研究构建的乳腺癌相关淋巴水肿患者抗阻训练方案具有一定的科学性、可行性，可以提高淋巴回流动力源中的肌肉收缩和胸腔负压，缓解淋巴水肿。

关键词: 乳腺癌, 淋巴水肿, 抗阻训练, 淋巴回流动力源, 护理

Abstract:

Objective To construct a resistance training program for breast cancer related lymphedema，and to examine its feasibility and effects. Methods The first draft of the resistance training program was developed based on the 2 intervenable factors of “muscle contraction” and “chest negative pressure” in lymphatic reflux power source and the best evidence of resistance training. The program was revised and its feasibility was analyzed through 2 rounds of expert demonstration and pilot study. The patients enrolled in 2022.1-2022.5 in a tertiary A hospital in Hefei were assigned to an experiment group（34 cases） and patients enrolled in 2022.9-2023.1 in a tertiary A hospital in Wuhu were assigned to an control group（34 cases） based on convenient sampling method. Both the experiment and control group were given comprehensive decongestive therapy with manual lymphatic drainage，wearing the pressure clothing，and skin care for 12 weeks. The patients in the experiment group were given additional resistance training for 12 weeks. Grip strength and extracellular water/intracellular water（ECW/ICW） of affected upper limb，forced expiratory volume in the first second（FEV₁） were evaluated before and 2，4，8，12 weeks after intervention. Results The resistance training program included 4 parts，including resistance breathing training，resistance muscle training，warm-up training and relaxation training. The expert authority coefficient is 0.89;the Kendall coordination coefficient of the first round of expert consultations is 0.42;the coefficient of variation is 0.08~0.27. The Kendall coordination coefficient of the second round of expert consultations is 0.67，and the coefficient of variation is 0~0.19. The pilot study results showed that the completion degree of 5 patients was 62.50%~100%，and there are no adverse events occurred during intervention. A total of 31 patients in the experimental group and 30 patients in the control group completed the 12-week intervention. The results of repeated measurement analysis of variance showed that the increase of grip strength in affected upper limb and FEV₁ value in the experiment group were significantly higher than that in the control group（P<0.05）;the reduction of ECW/ICW value in the experiment group was significantly greater than that in the control group（P<0.05）. Conclusion The resistance training program of breast cancer-related lymphedema is scientific and feasible. It can improve the “muscle contraction”and “chest negative pressure”of lymphatic reflux power source，and relieve lymphedema.

Key words: Breast Carcinoma, Lymphedema, Resistance Exercise, Lymphatic Reflux Power Source, Nursing Care

王玲, 尚少梅, 施月仙, 王翠. 抗阻训练改善乳腺癌术后患者淋巴水肿的效果评价[J]. 中华护理杂志, 2025, 60(2): 185-193.

WANG Ling, SHANG Shaomei, SHI Yuexian, WANG Cui. The effect of resistance training on alleviating lymphedema in breast cancer patients after surgery[J]. Chinese Journal of Nursing, 2025, 60(2): 185-193.

图/表 5

表1 乳腺癌相关淋巴水肿患者抗阻训练方案

Table 1 Resistance training program for breast cancer related lymphedema

表2 两组一般资料的比较

Table 2 Comparison of general data between 2 groups

表3 两组上肢握力的比较（kg，$\bar{x} \pm s$）

Table 3 Comparison of grip strength of affected upper limb between 2 groups（kg，$\bar{x} \pm s$）

表4 两组第1秒用力呼气容积的比较（L，$\bar{x} \pm s$）

Table 4 Comparison of forced expiratory volume in the first second between 2 groups（L，$\bar{x} \pm s$）

表5 两组患侧上肢的细胞外液量和细胞内液量比值的比较（$\bar{x} \pm s$）

Table 5 Comparison of ECW/ICW between 2 groups（$\bar{x} \pm s$）

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