| Objective To explore the effect and influence of rehabilitation combined nursing mode on shoulder joint motion,breast cancer related lymphedema and axillary web syndrome of patients after modified radical mastectomy.To evaluate the effect of rehabilitation combined nursing mode group on limb function after modified radical mastectomy,and to provide a reference mode for upper limb function exercise and rehabilitation.Methods From October 2019 to June 2020,104 patients with breast cancer modified radical mastectomy in a tertiary first-class hospital in Chongqing City were enrolled.They were randomly divided into the rehabilitation combined nursing mode group and the routine functional exercise group.4 cases were excluded and dropped during the trial.Each group had 50 cases.In the routine functional exercise group,nurses provided functional exercise guidance and health education.On this basis,the rehabilitation combined nursing mode group cooperated with rehabilitation specialists to evaluate the patient’s condition,formulate rehabilitation treatment plans,and implement rehabilitation measures for breast cancer patients.To complete the rehabilitation exercise program,rehabilitation practitioners and nurses worked together in a division of labor.The patients’ shoulder range of motion and upper limb circumference were measured 1 day before the operation,5 days after the operation,1,2,3 months after the operation,and the occurrence of breast cancer related lymphedema and axillary web syndrome in the two groups were observed.Results1 Comparative analysis of two groups of baseline dataThe following baseline data of breast cancer modified radical mastectomy patients included were statistically analyzed: age,body mass index,history of diabetes,disease stage,chemotherapy regimen,chemotherapy course,lymph node dissection,lymph node dissection range,education level,marital status,medical insurance type,there was no statistical difference between the two groups(P>0.05).2 Comparative analysis of the two groups of shoulder range of motionFor two groups,There was no significant difference in forward flexion(175.80±7.52 VS 173.20±6.29),extension(59.76±1.44 VS 59.40±2.35),abduction(175.40±7.68 VS 173.20±6.68),internal rotation(88.90±2.91 VS 87.80 ± 4.06)and external rotation(89.50± 2.08 VS 88.80 ± 3.72).Repeated-measure analysis of variance was performed on shoulder range of motion at 5 days after surgery,1,2,3 months after surgery.It was found that under the time effect,the longer the postoperative time,the more obvious the improvement in shoulder range of motion of the two groups(P<0.05).Under the grouping effect,there is a significant difference in shoulder range of motion between the two groups(P<0.05),indicating that the shoulder range of motion of the rehabilitation combined nursing mode group is better than the routine functional exercise group.The interaction between the grouping effect and the time effect below,the results of the two groups are significantly different(P<0.05).Through the change trend chart of the shoulder range of motion of the two groups,it is found that at the same time point,the shoulder range of motion of the rehabilitation combined nursing mode group is better than the routine functional exercise group.In addition,through the simple effect analysis found that there was no difference in shoulder range of motion between the two groups on the5 th day after surgery,and the flexion,extension,abduction,internal rotation and external rotation of patients in the rehabilitation combined nursing mode group at other time points(1,2,3 months after surgery)were better than the routine functional exercise group(P<0.05).3 Comparative analysis of the two groups of breast cancer related lymphedema3.1 Analysis of the difference in the arm circumference of the upper limbs in the two groupsThe breast cancer related lymphedema of the two groups was analyzed by the difference of arm circumference between the two groups.There was no significant difference between the two groups in ulnar stem process and the upper 10 cm、20cm、30cm、40cm of ulnar stem process one day before operation(P>0.05).Through repeated measurement analysis of variance on the difference between the upper limb arm circumferences of the two groups of patients at 5 days after surgery and 1,2,3 months after surgery,it was found that under the time effect,the difference between the two groups was statistically significant(P<0.05).The difference in arm circumference between the two groups increased with the postoperative time,indicating that the risk of breast cancer related lymphedema could increase with the postoperative time.Under the grouping effect,there was no statistical difference between the two groups(P>0.05).Under the interaction of grouping effect and time effect,the difference between the two groups was not statistically significant(P>0.05).3.2 Analysis of the occurrence of breast cancer related lymphedema in the two groupsThe two groups of breast cancer patients who had breast cancer related lymphedema within 3 months after operation were counted.There were 5cases of breast cancer related lymphedema,the incidence rate was 5%.Two cases of mild edema occurred in the rehabilitation combined nursing mode group,both occurred on the 5th day after surgery,and were related to the cause of the operation and poor drainage.Manual lymphatic drainage,finger acupuncture treatment,and drainage tube relocation were given.After being discharged from the hospital one month,the patients were significantly relieved.The remaining 3 cases occurred outside the hospital,2 cases resolved after 3 to 6 months of rehabilitation,and 1 case of moderate edema was still under treatment due to poor compliance.4 Comparative analysis of the incidence of axillary web syndrome in the two groupsChi-square test was used to analyze the incidence of axillary web syndrome in the two groups of breast cancer within 3 months after operation.The incidence of axillary web syndrome in the rehabilitation combined nursing mode group was 16.00%,and the incidence in the routine functional exercise group was twice that of the rehabilitation combined nursing mode group,Was 32.00%,but there was no statistical difference between the two groups(χ2=3.5,P=0.06).5 Safety analysisThe Mann-Whitney test was used to analyze the difference in the extubation time of the two groups of patients.The results showed that there was no significant difference in the extubation time of the axillary drainage tube between the two groups(Z=-0.65,P=0.52),but the extubation time of the chest wall drainage tube in the two groups was significant difference(Z=-2.09,P=0.04),the rehabilitation combined nursing mode can shorten the time of extubation of the patient’s chest wall drainage tube.In addition,1 case of wound necrosis occurred in the rehabilitation combined nursing mode group,2 cases of wound infection and 2 cases of effusion occurred in the routine functional exercise group.The number of complications in the rehabilitation combined nursing mode group was relatively small,indicating that the combined rehabilitation nursing mode is safe and feasible.And it can shorten the extubation time of the chest wall drainage tube.Conclusion: Rehabilitation combined nursing mode can promote the recovery of shoulder joint function in patients with breast cancer after modified radical mastectomy in the early postoperative period,and to a certain extent can prevent the occurrence of axillary web syndrome,reduce its incidence,and shorten the extubation time of the patient’s chest wall drainage tube.But compared with the routine functional exercise group,the rehabilitation combined nursing mode had no significant effect on breast cancer related lymphedema within 3 months after surgery.This mode gives full play to the advantages of rehabilitation and nursing disciplines.The division of labor between rehabilitation specialists and nurses promotes the recovery of upper limb functional status of postoperative patients,and provides a more systematic and professional rehabilitation mode for functional exercises after breast cancer modified radical mastectomy. |
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