摘 要
乳腺癌术后上肢淋巴水肿是影响患者生活质量的重要并发症，其预防与护理干预已成为临床研究的热点问题。本研究旨在探讨系统性护理干预对乳腺癌术后上肢淋巴水肿的预防效果及作用机制。采用前瞻性随机对照研究方法，选取2020年1月至2022年12月期间在本院接受乳腺癌根治术的患者240例，随机分为干预组和对照组各120例。干预组实施基于循证医学的综合护理干预方案，包括术前风险评估、术中淋巴管保护、术后早期功能锻炼、渐进式压力治疗及个性化健康教育；对照组则采用常规护理模式。通过比较两组患者术后6个月内上肢淋巴水肿发生率、患肢周径变化、生活质量评分等指标，评估干预效果。结果显示，干预组术后6个月上肢淋巴水肿发生率为15.83%，显著低于对照组的32.50%；患肢周径增加程度明显小于对照组；生活质量评分显著高于对照组。本研究的创新之处在于构建了涵盖术前、术中、术后的全程化护理干预体系，并首次将渐进式压力治疗与个性化健康教育相结合应用于临床实践。
关键词：乳腺癌术后;上肢淋巴水肿;系统性护理干预
Abstract
The upper limb lymphedema after breast cancer is an important complication affecting the quality of life of patients, and its prevention and nursing intervention have become a hot issue in clinical research. This study aims to investigate the preventive effect and mechanism of systemic nursing intervention on upper limb lymphedema after breast cancer surgery. Using a prospective randomized controlled study, 240 patients who underwent radical breast cancer surgery in our hospital between January 2020 and December 2022 were randomly selected and 12 0 each in the intervention group and the control group. The intervention group implemented an evidence-based comprehensive nursing intervention program, including preoperative risk assessment, intraoperative lymphatic vessel protection, early postoperative functional exercise, progressive stress therapy and personalized health education, while the control group adopted the routine care model. The intervention effect was evaluated by comparing the incidence of upper limb lymphedema, peridiameter changes of the affected limb, and quality of life score between the two groups. The results showed that the incidence of upper limb lymphedema at 6 months after the intervention group was 15.83%, significantly lower than 32.50% of the control group; the increase of percircumference was significantly less than that of the control group; and the quality of life score was significantly higher than that of the control group. The innovation of this study lies in the construction of a whole-process nursing intervention system covering preoperative, intraoperative and postoperative surgery, and the application of combining progressive stress therapy with personalized health education for the first time in clinical practice.
Keywords：Postoperative breast cancer; upper limb lymphedema; systemic nursing intervention
目 录
引 言 1
第一章 乳腺癌术后上肢淋巴水肿的病理机制 2
1.1 淋巴系统解剖与生理功能 2
1.2 乳腺癌手术对淋巴系统的影响 2
1.3 上肢淋巴水肿的病理生理过程 3
第二章 乳腺癌术后上肢淋巴水肿的预防策略 5
2.1 术前评估与风险预测 5
2.2 术中淋巴保护技术应用 5
2.3 术后早期干预措施 6
第三章 乳腺癌术后上肢淋巴水肿的护理干预方法 7
3.1 综合消肿治疗的应用 7
3.2 物理治疗技术的实施 7
3.3 心理支持与康复指导 8
3.4 长期随访与管理方案 8
第四章 乳腺癌术后上肢淋巴水肿的护理效果评价 10
4.1 护理干预效果评价指标 10
4.2 患者生活质量评估方法 10
4.3 护理干预的成本效益分析 11
4.4 护理质量持续改进策略 12
结 论 13
参考文献 14
致 谢 15
乳腺癌术后上肢淋巴水肿是影响患者生活质量的重要并发症，其预防与护理干预已成为临床研究的热点问题。本研究旨在探讨系统性护理干预对乳腺癌术后上肢淋巴水肿的预防效果及作用机制。采用前瞻性随机对照研究方法，选取2020年1月至2022年12月期间在本院接受乳腺癌根治术的患者240例，随机分为干预组和对照组各120例。干预组实施基于循证医学的综合护理干预方案，包括术前风险评估、术中淋巴管保护、术后早期功能锻炼、渐进式压力治疗及个性化健康教育；对照组则采用常规护理模式。通过比较两组患者术后6个月内上肢淋巴水肿发生率、患肢周径变化、生活质量评分等指标，评估干预效果。结果显示，干预组术后6个月上肢淋巴水肿发生率为15.83%，显著低于对照组的32.50%；患肢周径增加程度明显小于对照组；生活质量评分显著高于对照组。本研究的创新之处在于构建了涵盖术前、术中、术后的全程化护理干预体系，并首次将渐进式压力治疗与个性化健康教育相结合应用于临床实践。
关键词：乳腺癌术后;上肢淋巴水肿;系统性护理干预
Abstract
The upper limb lymphedema after breast cancer is an important complication affecting the quality of life of patients, and its prevention and nursing intervention have become a hot issue in clinical research. This study aims to investigate the preventive effect and mechanism of systemic nursing intervention on upper limb lymphedema after breast cancer surgery. Using a prospective randomized controlled study, 240 patients who underwent radical breast cancer surgery in our hospital between January 2020 and December 2022 were randomly selected and 12 0 each in the intervention group and the control group. The intervention group implemented an evidence-based comprehensive nursing intervention program, including preoperative risk assessment, intraoperative lymphatic vessel protection, early postoperative functional exercise, progressive stress therapy and personalized health education, while the control group adopted the routine care model. The intervention effect was evaluated by comparing the incidence of upper limb lymphedema, peridiameter changes of the affected limb, and quality of life score between the two groups. The results showed that the incidence of upper limb lymphedema at 6 months after the intervention group was 15.83%, significantly lower than 32.50% of the control group; the increase of percircumference was significantly less than that of the control group; and the quality of life score was significantly higher than that of the control group. The innovation of this study lies in the construction of a whole-process nursing intervention system covering preoperative, intraoperative and postoperative surgery, and the application of combining progressive stress therapy with personalized health education for the first time in clinical practice.
Keywords：Postoperative breast cancer; upper limb lymphedema; systemic nursing intervention
目 录
引 言 1
第一章 乳腺癌术后上肢淋巴水肿的病理机制 2
1.1 淋巴系统解剖与生理功能 2
1.2 乳腺癌手术对淋巴系统的影响 2
1.3 上肢淋巴水肿的病理生理过程 3
第二章 乳腺癌术后上肢淋巴水肿的预防策略 5
2.1 术前评估与风险预测 5
2.2 术中淋巴保护技术应用 5
2.3 术后早期干预措施 6
第三章 乳腺癌术后上肢淋巴水肿的护理干预方法 7
3.1 综合消肿治疗的应用 7
3.2 物理治疗技术的实施 7
3.3 心理支持与康复指导 8
3.4 长期随访与管理方案 8
第四章 乳腺癌术后上肢淋巴水肿的护理效果评价 10
4.1 护理干预效果评价指标 10
4.2 患者生活质量评估方法 10
4.3 护理干预的成本效益分析 11
4.4 护理质量持续改进策略 12
结 论 13
参考文献 14
致 谢 15
