乳腺癌相关淋巴水肿患者运动指导方案的证据总结

目的 评价并总结乳腺癌相关淋巴水肿运动指导的相关证据,为医护人员对淋巴水肿患者采取运动干预提供依据。方法 系统检索BMJ Best Practice、UpToDate、Cochrane Library、Joanna Briggs Institute（JBI）循证卫生保健国际合作中心图书馆、JBI在线临床治疗及护理证据网络、英国国家卫生与临床优化研究所网站、美国国立指南库、国际指南协作网、苏格兰校际指南网络、美国国立综合癌症网络、加拿大安大略注册护士协会网站、国际淋巴水肿网站、国际淋巴水肿协会网站、PubMed、CINAHL、Embase、Web of Science、Physiotherapy Evidence Database、中国指南网、中国知网、万方、中国生物医学文献服务系统、维普数据库关于乳腺癌相关淋巴水肿运动方面的指南、专家共识、证据总结、系统评价等证据,检索时间为建库至2019年7月,由2名具有循证护理知识的研究人员独立对文献进行质量评价和证据级别评定。结果 共纳入19篇文献,包括1篇临床决策,1篇推荐实践,1篇证据总结,5篇指南,3篇专家共识,8篇系统评价,从运动禁忌证、运动前评估、运动前测试、运动强度、运动安全性、运动方案、注意事项、健康教育8个方面汇总23条最佳证据。 结论 运动干预可改善淋巴水肿症状,医护人员需结合临床情境,考虑患者的意见,为淋巴水肿患者提供个性化的运动指导,发挥运动疗效,以进一步提高患者的生活质量。

Evidence summary of exercise programs on patients with breast cancer-related lymphedema

Objective To evaluate and summarize the best evidence of exercise instructions for breast cancer-related lymphedema,and to provide references for clinical practice. Methods We searched BMJ Best Practice,UpToDate,Cochrane Library,Joanna Briggs Institute（JBI） Library,JBI Clinical Online Network of Evidence for Care and Therapeutics（JBI CONNECT+）,National Institute for Health and Clinical Excellence（NICE）,National Guideline Clearinghouse（NGC）,Guideline International Network（GIN）,Scottish Intercollegiate Guidelines Network（SIGN）,National Comprehensive Cancer Network（NCCN）,Registered Nurses’ Association of Ontario（RNAO）,National Lymphedema Network（NLN）,International Society of Lymphology（ISL）,PubMed,CINAHL,Embase,Web of Science,Physiotherapy Evidence Database,China Guideline Clearinghouse,CNKI,Wanfang Database,CBM and VIP Database to collect guidelines,expert consensuses,evidence summaries and systematic reviews on exercise for patients with breast cancer-related lymphedema. The retrieval period was from the inception of databases to July 2019. 2 researchers with evidence-based nursing background assessed the quality of the literature independently and identified the level of evidence. Results A total of 19 articles were incorporated,including 1 clinical decision,1 clinical practice recommendation,1 evidence summary,5 guidelines,3 expert consensuses,8 systematic reviews. A total of 23 pieces of best evidence including 8 dimensions were summarized,namely contraindication,pre-exercise assessment,pre-exercise test,exercise intensity,safety,exercise program,announcements and health education related exercise. Conclusion Exercise interventions can alleviate symptoms of lymphedema. Clinical staff should consider patients’ opinions and provide personalized exercise programs for patients with breast cancer-related lymphedema according to the clinical situation,in order to further improve effectiveness of the exercise and quality of life of patients.