目的: 分析乳腺癌手术患者发生上肢功能障碍的危险因素,构建影响上肢功能障碍的危险因素风险模型并验证其性能。方法: 2021年2月至2022年2月选取350例已行乳腺癌改良根治术2～5个月的女性患者进行非匹配的病例对照研究。经过Rowe肩关节评估量表评定,将评分＜75分者作为病例组,评分≥75分者作为对照组。采用Logistic统计分析乳腺癌手术患者上肢功能障碍的危险因素,构建列线图风险预测模型并进行内部验证。结果: 大学及以上文化水平、满意夫妻关系、高水平自我效能是乳腺癌手术患者上肢功能障碍的保护因素(P＜0.05);年龄65～80岁、伤口痛、失眠、极少主动运动上肢、非常恐惧运动、复发乳腺癌、从不渴望娱乐活动、一点也不和朋友亲近是乳腺癌手术患者上肢功能障碍的危险因素(P＜0.05)。将以上因素纳入并构建列线图风险预测模型,结果显示,伤口疼痛、夫妻关系、失眠、主动运动上肢等可干预因素对乳腺癌手术患者上肢功能障碍发生风险影响较大。内部验证结果显示模型的ROC曲线下面积为0.858。校正曲线表明列线图预测出的乳腺癌上肢功能障碍发生风险和实际发生风险之间有较好的一致性,校正后C指数为0.837。结论: 构建的乳腺癌手术患者上肢功能障碍的危险因素风险模型的预测效果较好,可以辅助临床医护人员筛选影响上肢功能障碍的高风险因素,尤其是可干预的疼痛症状、失眠症状、主动运动行为及夫妻关系等,采取早期应对措施,促进术后康复。
Objective: To analyze the risk factors of upper limb dysfunction in breast cancer surgery patients,to construct the risk model of the risk factors affecting upper limb dysfunction and to verify its performance.Methods: From February 2021 to February 2022, 350 women who had passed 2 to 5 months after modified radical breast cancer surgery were selected for an unmatched case-control study. After assessment by Rowes rating System for Bankart repair, those with a score of <75 points were as the case group and those with a score of ≥75 points were as the control group. Logistic statistical analysis was used to analyze the risk factors of upper limb dysfunction in breast cancer surgery patients, to construct the nomogram risk prediction model and to verify it internally. Results: University degree or above, satisfactory marital relationship and high level of self-efficacy were protective factors for upper limb dysfunction in breast cancer surgery patients (P＜0.05). Aged 65 to 80 years, wound pain, insomnia, rarely active upper limb exercise, very fear of exercise, recurrence of breast cancer, no desire for recreational activities, and not being close to friends were the risk factors for upper limb dysfunction of breast cancer surgery patients (P＜0.05). The above factors were included and the nomogram risk prediction model was built. The results showed that intervention factors such as wound pain, marital relationship, insomnia and active upper limb movement had a great impact on the risks of upper limb dysfunction in breast cancer surgery patients. Internal verification results showed that the area under the ROC curve of the model was 0.858. The calibration curve showed a good consistency between the risks of breast cancer upper limb dysfunction predicted by the nomogram and the actual risks, and the C index was 0.837 after correction. Conclusion: The constructed risk model of risk factors for upper limb dysfunction in patients with breast cancer surgery has a good prediction effect. It can assist clinical medical and nursing staff to screen high risk factors affecting upper limb dysfunction, especially pain symptoms, insomnia symptoms, active movement behavior, marital relationship and other factors that can be intervened. This allows for early response measures and postoperative rehabilitation.
[1] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin, 2021,71(3):209-249.
[2] Sancho-garnier H, Colonna M. Breast cancer epidemiology[J].Presse Med, 2019,48(10):1076-1084.
[3] 张世达,童真,张铎. 保乳术与改良根治术治疗乳腺癌患者临床对比分析[J].贵州医药, 2020, 44(3): 406-408.
[4] 褚彦青,李淑军,焦峰丽,等. 乳腺癌患者文化水平对术后患侧肢体功能恢复的研究[J].河北医药, 2015, 37(8):1253-1255.
[5] 吴婧. 乳腺癌根治术后颈肩部疼痛功能障碍评估及影响因素分析[D].天津:天津体育学院, 2017.
[6] Machin D, Campbell MJ, Tan SB, et al. Sample size tables for clinical studies[M].Oxford: Wiley, 2008.
[7] Hidding JT, Beurskens CHG, Van Der Wees PJ, et al. Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review[J].PLoS One, 2014,9(5): e96748.
[8] 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2019年版)[J].中国癌症杂志, 2019, 29(8): 609-680.
[9] 张明涛,刘嘉鑫,杨智涛,等. 关节镜自体骨软骨移植治疗复发性肩关节前脱位早期疗效[J].中国骨伤, 2022, 35(3):233-237.
[10] 刘延锦,王敏,董小方,等. 中文版乳腺癌幸存者自我效能感量表信效度分析[J].中国全科医学, 2016, 19(27):3336-3340.
[11] 陈惟义,周泽文,刘颖春,等. 广西35～74岁壮族人群睡眠状况及其影响因素分析[J].现代预防医学, 2022, 49(2):289-294.
[12] 张丽,张晓娜,陈长香,等. 丈夫态度及社会支持对乳腺癌患者性功能障碍的影响[J].现代预防医学, 2017, 44(23): 4318-4321, 4331.
[13] 王惠惠,李娜,李燕,等. 社会支持对乳腺癌幸存者癌症复发恐惧的影响: 心理复原力的中介效应[J].军事护理, 2022(10): 17-20.
[14] De Groef A, Van Kampen M, Tieto E, et al. Arm lymphoedema and upper limb impairments in sentinel node-negative breast cancer patients: a one year follow-up study[J].Breast, 2016,29:102-108.
[15] 蔡中博,方桂珍. 乳腺癌术后病人肩关节功能障碍影响因素的研究进展[J].护理研究, 2016, 30(30): 3730-3734.
[16] 肖旭. 乳腺癌术后淋巴水肿影响因素研究[D].昆明: 昆明医科大学, 2021.
[17] Siqueira TC, Frágoas SP, Pelegrini A, et al. Factors associated with upper limb dysfunction in breast cancer survivors[J].Support Care Cancer, 2021,29(4):1933-1940.
[18] Kim A, Yang EJ, Ji M, et al. Distorted body schema after mastectomy with immediate breast reconstruction: a 4-month follow up study[J].PeerJ, 2022,10:e14157.
[19] Schmidt ME, Wiskemann J, Steindorf K. Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis[J].Qual Life Res, 2018,27(8):2077-2086.
[20] Lourencço A, Dantas AAG, De Souza JC, et al. Sleep quality is associated with disability and quality of life in breast cancer survivors: a cross-sectional pilot study[J].Eur J Cancer Care (Engl), 2020, 8: e13339.
[21] Redemski T, Hamilton DG, Schuler S, et al. Rehabilitation for women undergoing breast cancer surgery: a systematic review and meta-analysis of the effectiveness of early, unrestricted exercise programs on upper limb function[J].Clin Breast Cancer, 2022,22(7):650-665.
[22] Karadibak D, Yavuzsen T, Saydam S. Prospective trial of intensive decongestive physiotherapy for upper extremity lymphedema[J].J Surg Oncol, 2008,97(7):572-577.
[23] Feyzioğlu ö, DinINcçer S, Akan A, et al. Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery?[J].Support Care Cancer, 2020,28(9):4295-4303.
[24] 孙凤莉. 乳腺癌术后患者院外功能锻炼依从性及其影响因素的研究[D].滨州:滨州医学院, 2020.
