Suitability of single tissue dielectric constant measurements to assess local tissue water in normal and lymphedematous skin

Previous reports described the use of average tissue dielectric constant (TDC) measurements to assess local tissue water and its change. Our goal was to determine if a single TDC measurement could be used in place of the average of multiple measurements. The comparison criteria used to test this was the extent to which single and averaged measurements yielded similar TDC values in both normal and lymphedematous tissue. Measurements were made in two groups of women; a control group (n = 20) and a group with unilateral arm lymphedema (n = 10). In the control group, TDC was measured to multiple depths (0·5–5·0 mm) on both ventral forearms and to a depth of 2·5 mm on the lateral thorax on both body sides. In the lymphedematous group, TDC was measured on both ventral forearms to a depth of 2·5 mm. Results showed that the 95% confidence interval for differences between single and averaged TDC values was less than ±1 TDC unit and that the limits of agreement between methods was less than ±2·5 TDC units (±6·5%) for each condition, site and depth measured. This finding suggests that where this level of agreement is acceptable suitable clinical assessments can be made using a single TDC measurement.     

中药湿热敷联合穴位按摩在中重度乳腺癌术后上肢淋巴水肿患者中的应用研究

摘要：目的 探究中药湿热敷联合穴位按摩在中重度乳腺癌术后上肢淋巴水肿患者中的应用效果。方法 采用随机数字表法，将80例患者按照1:1的比例随机分为观察组与对照组。对照组给予综合消肿治疗(CDT)，观察组在对照组基础上给予中药湿热敷联合穴位按摩。中药湿热敷所用的外敷方是由上海市名老中医叶景华拟定，成分包括伸筋草、透骨草、络石藤、续断、王不留行各150g 及乳香、蛇六谷各300g；选择肩髃穴、曲池穴、内关穴、合谷穴、丰隆穴为按摩穴位，治疗周期28天，比较两组临床疗效。结果 两组患者在患肢臂围周径、上肢功能活动度以及症状个数、症状严重程度、症状困扰、功能、社交、情绪及归属感方面具有统计学意义(P＜0.05)；在性生活、睡眠方面无统计学意义(P＞0.05)。结论 通过中药湿热敷联合穴位按摩对中重度乳腺癌术后上肢淋巴水肿患者进行干预，可以在消肿综合治疗基础上有效缓解患者患肢手臂围周径、上肢功能活动度及相关症状等表现，为今后临床实践提供依据。     

肢体三维测量装置的设计及应用

目的 探讨自行设计的肢体三维测量装置在测量淋巴水肿患者肢体肿胀程度方面的应用效果。 方法 选择2018年7月至2018年12月在我院淋巴水肿专病门诊就诊的患者60例,按照随机数字表法分为实验组(n=30)和对照组(n=30),实验组采用肢体三维测量装置评估患者治疗前后患侧肢体的肿胀程度,对照组采用传统的软尺测量+不可擦记号笔做标记的方法测量患者治疗前后患侧肢体的周径变化情况。 结果 两组不同测量方法护士所需时间比较,实验组护士所花时间明显低于实验组(P＜0.05),满意度评价中实验组的满意率明显高于对照组(P＜0.05),护士操作难易度比较中,实验组护士认为操作简单的明显高于对照组(P＜0.05)。结论 自行设计的肢体三维测量装置可以提高患者的满意度,方便护士操作,值得临床推广。     

淋巴水肿上肢体积测量装置的设计及应用

目的 探讨自行设计的淋巴水肿上肢体积测量装置在测量淋巴水肿患者肢体肿胀程度方面的应用效果。 方法 选择2018年7月至2018年12月在我院淋巴水肿专病门诊就诊的患者70例,按照随机数字表法分为观察组(n=35)和对照组(n=35),观察组采用淋巴水肿上肢体积测量装置评估患者治疗前后患侧肢体的肿胀程度,对照组采用传统的软尺测量+不可擦记号笔做标记的方法测量患者治疗前后患侧肢体的周径变化情况。 结果 满意度评价中观察组的满意率明显高于对照组(P＜0.05),护士操作难易度比较中,观察组护士认为操作简单的频率明显高于对照组(P＜0.05)。 结论 自行设计的淋巴水肿上肢体积测量装置可以提高患者的满意度,方便护士操作,值得临床推广。     

Lymphedema diagnosis and management

PURPOSE: To provide advanced practice nurses with a greater understanding of the pathophysiology, clinical manifestations, diagnosis, and management of lymphedema. DATA SOURCES: Comprehensive literature review of the relevant clinical journals, systematic reviews, and medical textbooks. CONCLUSIONS: Lymphedema is a poorly known and understood condition. If not properly diagnosed and promptly treated, lymphedema can cause significant morbidity and mortality. Diagnosis is based on suggestive history and characteristic findings on physical exam that ideally would be confirmed by lymphoscintigraphy. The primary goal in lymphedema treatment is the removal of excess plasma proteins from the interstitial tissues. The goals of management are to decrease the extremity size, maintain the decreased size, prevent complications, and improve function and overall sense of psychological well-being. IMPLICATIONS FOR PRACTICE: The ability to properly diagnose lymphedema is crucial to prevent the significant morbidity and mortality that is associated with this condition. It is imperative that patients with lymphedema are referred to specially trained healthcare professionals to ensure optimal treatment.     

乳腺癌相关淋巴水肿间歇气压治疗的研究

目的评估间歇气压疗法对乳腺癌术后上肢淋巴水肿的治疗效果。方法对我院2004年1月～2007年6月收治的68例乳腺癌相关淋巴水肿进行间歇气压治疗的患者进行上臂和前臂周径测量,并对治疗前后进行前瞻性研究。结果治疗前上臂和前臂周径分别为30.6±4.3cm和26.5±3.6cm,间歇空气压力治疗3周后测量上臂和前臂周径分别为25.6±3.8cm和24.2±3.2cm。上臂周径差值(患肢-健肢)治疗前后分别为5.8±0.9cm和2.3±0.7cm,治疗前后上臂周径差值比较差异有显著性意义(P<0.05)。结论间歇气压治疗作为综合治疗的一部分,在乳腺癌相关淋巴水肿的治疗中疗效满意、安全且具有良好的依从性。     

乳腺癌相关淋巴水肿影像学评估进展

乳腺癌相关淋巴水肿(BCRL)是治疗乳腺癌后常见严重并发症，早期干预可有效改善临床症状，防止发生不可逆组织学变化。随着医学影像学技术的进步，越来越多的影像学方法用于诊断和评估BCRL。本文就淋巴闪烁显像、吲哚菁绿淋巴造影、MR淋巴造影和超声评估BCRL进展进行综述。     

乳腺癌术后上肢淋巴水肿的护理管理

上肢淋巴水肿是乳腺癌术后常见症状之一,可导致上肢功能障碍和精神压抑,严重影响乳腺癌患者的生活质量,护士应该重视乳腺癌上肢淋巴水肿问题,指导患者对淋巴水肿进行管理,缓解症状,提高生活质量。     

等速肌力训练对乳腺癌术后淋巴水肿的疗效观察

目的:探讨肩关节内收等速肌力训练对乳腺癌术后淋巴水肿的影响。方法:乳腺癌术后并发上肢水肿患者68例,随机分为等速组和对照组,每组各34例。2组均给予常规康复训练,等速组在此基础上进行肩关节内收等速肌力训练。训练前后采用放射性核素淋巴扫描观测2组患侧上肢淋巴流量的变化;在腕横纹上10cm处测量2组双侧上臂周径;应用等速肌力测试系统为等速组记录等速肌力测定值。结果:治疗2个月后,2组患者上肢淋巴流量均较组内治疗前增加(P<0.05),双侧上臂周径差值均较组内治疗前减小(P<0.05),与对照组治疗后比较,等速组上肢淋巴流量较大(P<0.05),双侧上臂周径差值较小(P<0.05)。治疗后,等速组患者等速肌力测量值(峰力矩、总功率、平均功率)均较治疗前明显增加(P<0.05)。结论:肩关节内收等速肌力训练可以增加乳腺癌术后患侧上肢淋巴回流量,有效减少淋巴水肿。     

乳腺癌术后上肢淋巴水肿病人自我感受负担与自我护理能力的相关性研究

目的:了解乳腺癌术后上肢淋巴水肿病人的自我感受负担、自我护理能力,并探讨二者的相关性。方法:采用方便抽样方法选取在中山大学肿瘤防治中心就诊的187例乳腺癌术后上肢淋巴水肿病人进行问卷调查。结果:乳腺癌术后上肢淋巴水肿病人自我感受负担总分为(30.40±7.65)分,自我护理能力总分为(109.36±18.57)分。自我感受负担与自我护理能力呈负相关(P<0.05)。结论:多数乳腺癌术后上肢淋巴水肿病人存在中重度自我感受负担,且自我护理能力有待提高。护理人员应关注病人的心理问题,及时进行心理疏导,同时提高病人的自我护理能力,减轻其心理负担。     

核素淋巴显像在下肢淋巴水肿诊断中的应用

本文对44名下肢水肿患者进行了核素淋巴显像,以探讨下肢淋巴显像的应用价值。图像按正常回流、不完全性梗阻及完全性梗阻进行分型与分析,结果表明:淋巴显像诊断下肢淋巴性水肿的灵敏度及特异性分别为88.4％及95.6％,15例患者按显像所示淋巴管梗阻部位进行了静脉一淋巴管吻合术,治疗总有效率达93.3％。研究提示核素淋巴显像不但具有安全、无创与简便的优点,而且能准确显示淋巴回流功能及梗阻部位,为治疗方法选择提供指导,具有较高的临床应用价值。     

睡眠支架预防乳腺癌患者术后患侧上肢淋巴水肿的效果

目的探讨睡眠支架对预防乳腺癌患者术后患侧上肢淋巴水肿的应用效果。方法便利抽样法选取南京市某三级甲等综合性医院住院的乳腺癌患者为研究对象。以2016年1-2月在普外乳腺科行乳腺癌改良根治术的56例患者为对照组;2016年3月在普外乳腺科行乳腺癌改良根治术的60例患者为观察组。对照组术后采用常规护理,观察组术后给予睡眠支架抬高患侧上肢,比较两组患者术后早期患侧上肢淋巴水肿发生情况、疼痛感及对护理工作的满意度。结果观察组乳腺癌患者术后患侧上肢水肿发生率及疼痛程度低于对照组,患者对护理工作的满意度则高于对照组,两组比较差异有统计学意义(均P0.05)。结论使用睡眠支架可有效预防和减少乳腺癌患者术后患侧上肢淋巴水肿的发生,缓解术后疼痛,提高主观舒适度,促进患者康复,从而提高患者对护理工作的满意度。     

带淋巴结复合组织瓣游离移植治疗上肢淋巴水肿围术期护理

目的 探讨带淋巴结复合组织瓣游离移植治疗上肢淋巴水肿的围术期护理措施。方法 12例带淋巴结复合组织瓣游离移植治疗上肢淋巴水肿患者围手术期护理进行总结。结果 12例腹股沟带淋巴结复合组织瓣游离移植全部成活,患侧上肢淋巴水肿逐渐消退。结论 严密细致的观察和行之有效的护理措施可促进患者术后恢复,是带淋巴结复合组织瓣游离移植治疗上肢淋巴水肿患者手术成功的重要保证。     

生物电阻抗早期监测乳腺癌术后上肢淋巴水肿的敏感性与特异性研究

目的:研究生物电阻抗监测相对于主观症状体征问卷调查对乳腺癌术后上肢淋巴水肿早期诊断的敏感性与特异性。方法:筛选2016年10月—2017年3月在复旦大学附属华山医院静安分院确诊为乳腺癌并行根治术,符合研究标准的患者。给予受试者主观症状体征问卷调查、生物电阻抗分析设备(bioimpedance spectroscopy,BIS)监测和定点臂围测量,并记录其在术后2周及术后6个月的BIS监测结果及问卷调查、定点臂围测量结果。以患者的健侧与患侧臂围差值作为标准,计算BIS相对于主观症状体征问卷调查对上肢淋巴水肿诊断的敏感性和特异性。结果:以患者的健侧与患侧臂围差值作为参考标准,对88例病例进行分析后,主观症状体征问卷调查诊断的敏感性为94.4%,特异性为96.1%;BIS监测淋巴水肿的敏感度为97.2%,特异性为80.8%。结果显示BIS监测相对于症状体征评定,诊断淋巴水肿敏感性高,特异性差(P0.05)。结论:BIS监测相对于主观症状体征问卷调查,更易诊断淋巴水肿及发现隐匿性淋巴水肿。     

Health‐related quality of life and associated factors in patients with primary lymphedema

Aim: Primary lymphedema requires continuous conservative treatment during the patient's life, which may affect their health‐related quality of life (HRQOL). Physical and psychosocial characteristics related to lymphedema are associated with their HRQOL. This study aimed to assess HRQOL in those patients undergoing conservative treatment and to determine the factors associated with their HRQOL. Methods: This was a cross‐sectional, observational study that included 83 patients with primary lymphedema at an outpatient clinic for lymphedema. HRQOL was assessed with the Medical Outcomes Study 36‐Item Short Form Survey (SF‐36) and EuroQol 5‐Dimension (EQ‐5D). Lymphedema status/complications and psychosocial status were evaluated by medical records, physical assessment, and self‐administrative questionnaires. Results: The general health perception score in the SF‐36 was lower than the age‐ and sex‐stratified national norms (P = 0.001). In the EQ‐5D, the proportions of patients with some/moderate or severe problems were 42.2% for pain/discomfort, 21.7% for usual activities, and 20.5% for anxiety/depression. By multiple regression analyses, a lower physical component summary score in the SF‐36 was associated with a higher lymphedema stage (P = 0.021), cellulitis within 30 days (P = 0.003), exercise (P = 0.010), and more substance use coping (P = 0.012). A lower mental component summary score was associated with skin lesions over edematous limbs (P = 0.008), less humor coping (P = 0.005), and more self‐blame coping (P = 0.014). Conclusion: Patients with primary lymphedema have problems in health perception, discomfort, usual activities, and anxiety/depression. Preventing cellulitis and skin lesions and humor coping may be able to improve HRQOL.     

乳腺癌术后上肢淋巴水肿的护理研究进展

从乳腺癌术后上肢淋巴水肿的发病机制、影响发生淋巴水肿的因素及护理方面综述了乳腺癌术后上肢淋巴水肿的护理研究进展.     

The feasibility of psychometric measures for body image and lymphedema for routine practice

The aim of this study is to assess the feasibility of the Male Genital Self‐Image Scale (MGSIS‐5) and Groin and Lower Limb Lymphedema questionnaire (G3L‐20) in a community sample of cisgender men aged 40 years and older. Psychometric measures can aid urologic practice by prompting patients to talk about aspects of their body that are either too sensitive or a natural part of aging. Importantly, reliable and valid measures can also contribute to an evidenced‐based‐practice‐based‐evidence cycle where they can establish the impact of changes recommended by research while using the results in turn to inform research. In this study, we examine two psychometric measures on the opposite ends of a psychological‐physical continuum; the MGSIS‐5 and the G3L‐20. A non‐experimental psychometric design was employed, administering the questionnaires online to a community sample of cisgender men aged 40 years old and above. Validity and reliability analyses were conducted. Thirty men completed the study; 14 aged 40 to 49, 14 aged 50 to 59 and 2 aged 60 to 69. The MGSIS‐5 and G3L‐20 show acceptable reliability and validity with one‐ and three‐component structures, respectively. The MGSIS‐5 and G3L‐20 show sufficient feasibility to justify the resources for studies with larger community samples and for pilot studies with clinical populations.