Abstract:

Objective To construct a management program for upper limb lymphedema prevention in postoperative breast cancer patients and to evaluate its effectiveness. Methods The first draft of the upper limb lymphedema prevention and management protocol for postoperative breast cancer patients was constructed on the basis of evidence summaries and qualitative interviews，and 2 rounds of correspondence were conducted in December 2022. Using the convenience sampling method，patients undergoing surgery for malignant tumours in the breast surgery department of a tertiary-level hospital in Zhengzhou City were selected as the study subjects，and 58 patients admitted from January to March 2023 were included in the experimental group according to the time of their first visit. 57 patients admitted from July to December 2022 were included in the control group and were given routine care. The rates of lymphedema occurrence，upper limb function score and patients’ adherence to lymphedema prevention behaviours after 1，3，and 6 months of intervention were compared between the 2 groups. Results The valid questionnaire recovery rates of the 2 rounds of expert correspondence were 92.59% and 100%，and the authority coefficients of the experts were 0.940 and 0.950，and the Kendall’s harmony coefficients were 0.228 and 0.254，respectively（P<0.001）. The coefficients of variation of the 2nd round of correspondence were 0.07~0.24. The final draft of the programme included 5 first-level entries，12 second-level entries，and 32 third-level entries. During the application of the programme，a total of 5 cases were dislodged，and 55 cases were finally included in each of the experimental and control groups. The results of repeated measures ANOVA showed that there was an interaction effect between the upper limb function scores and lymphedema prevention behavior compliance scores before intervention and at 1，3，and 6 months after discharge between the 2 groups（P<0.05）. Simple effects analysis showed that at 1，3，and 6 months after discharge, the upper limb function score and lymphedema prevention behavior compliance score of the experimental group were better than those of the control group, and the differences were statistically significant（P<0.05）. At 6 months post-intervention，the difference in the occurrence of lymphedema was statistically significant when comparing the 2 groups（P=0.032）. Adverse events such as subcutaneous bruising and falls did not occur in either group. Conclusion The upper limb lymphoedema prevention and management programme for postoperative breast cancer patients constructed in this study is scientific，feasible and safe，and can effectively reduce the incidence of lymphoedema in patients and improve their quality of life.

Key words: Breast Cancer, Lymphedema, Upper Limb Dysfunction, Prevention, Program Construction, Nursing Care

摘要：

目的 构建乳腺癌术后患者上肢淋巴水肿预防方案并评价其效果。 方法 在证据总结和半结构式访谈的基础上，构建乳腺癌术后患者上肢淋巴水肿预防方案初稿，于2022年12月进行2轮专家函询。采用便利抽样法，选取郑州市某三级甲等医院乳腺外科恶性肿瘤手术患者为研究对象，根据首次就诊时间，将2023年1月—3月收治的58例患者纳入试验组，实施乳腺癌术后患者上肢淋巴水肿预防方案。将2022年7月—12月收治的57例患者纳入对照组，予以常规护理。比较两组出院后1、3、6个月淋巴水肿发生率、上肢功能得分、淋巴水肿预防行为依从性得分。 结果 2轮函询问卷的有效回收率分别为92.59%、100%，专家权威系数分别为0.940、0.950，肯德尔和谐系数分别为0.228、0.254（均P<0.001）。第2轮函询的变异系数为0.07~0.24。方案终稿包括一级指标5项、二级指标12项、三级指标32项。方案应用过程中，共脱落5例，试验组和对照组各纳入55例。重复测量方差分析结果显示，两组干预前和出院后1、3、6个月的上肢功能得分、淋巴水肿预防行为依从性得分的时间与组间存在交互效应（P<0.05）；简单效应分析显示，出院后1、3、6个月，试验组的上肢功能得分、淋巴水肿预防行为依从性得分均优于对照组，差异具有统计学意义（P<0.05）。出院后6个月，两组淋巴水肿发生率比较，差异有统计学意义（P=0.032）。两组均未发生皮下淤血、跌倒等不良事件。 结果 该研究构建的乳腺癌术后患者上肢淋巴水肿预防方案具有科学性、可行性及安全性，可有效降低患者淋巴水肿的发生率，提高患者的生活质量。

关键词: 乳腺癌, 淋巴水肿, 上肢功能障碍, 预防, 方案构建, 护理