婦癌婦女預防下肢淋巴水腫臨床照護指引

Development of a Clinical Guideline for Preventing Lower Limb Lymphedema in Patients with Gynecologic Cancer

李星嬋(Shin‐Chan Lee) ； 林呈鳳(Cheng‐Feng Lin) ； 許耿福(Keng ‐ Fu Hsu) ； 許玉雲(Yu‐Yun Hsu)

《台灣復健醫學雜誌》 44卷1期 (2016/03) Pp. 29-42

https://doi.org/10.6315/2016.44(1)04

摘要

背景：婦癌患者接受腫瘤併淋巴結手術切除後，易出現下肢淋巴水腫，而淋巴水腫會進一步導致生理不適及影響婦女生活品質。目的：本文為發展婦癌（排除乳癌）患者術後預防下肢淋巴水腫臨床照護指引，及評值執行此指引後之成效。方法：「婦癌婦女預防下肢淋巴水腫臨床照護指引」(CGP-3L- in- GC)之發展流程包括:選定指引主題並建構臨床問題、系統性文獻查證與證據評讀、擬訂照護指引草案、兩回合德菲法共識決策、執行臨床試作並評價，最後以AGREE(Appraisal of Guidelines Research and Evaluation)進行指引外部評估。結果：根據12 篇實證文獻和一篇已發表的淋巴水腫照護指引擬定「婦癌婦女預防下肢淋巴水腫臨床照護指引」，並經由德菲法共識確認指引後，此指引以實驗法進行臨床試作，15 位實驗組術後婦女採用此臨床照護指引；14 位對照組婦女則採病房一般性照護。臨床試作結果顯示，實驗組婦女比對照組婦女出現中重度下肢淋巴水腫比例顯著較少(p＝.049)。實驗組婦女自我執行此照護指引後一個月，在生活品質的自覺健康狀態(Z＝-2.33, p＝.02)及生理方面(Z＝-2.0, p＝.047)比執行此指引前有顯著提升，但對照組婦女在後測一個月之生活品質無顯著提升。將此臨床試作結果作為指引修正依據，隨後以AGREE 進行本指引之外部評估，結果為「強烈建議」使用。結論：「婦癌婦女預防下肢淋巴水腫臨床照護指引」在時間太短和個案數少因素下，無法證實可顯著減少下肢淋巴水腫發生率。但醫護人員可依循此指引，提供婦癌婦女於術後預防下肢淋巴水腫更適切且有效的照護。

關鍵字

婦癌婦女(gynecologic cancer) ； 臨床照護指引(clinical guideline) ； 下肢淋巴水腫(lower limb lymphedema)

並列摘要

Background: Women receiving gynecological cancer surgery with lymph node dissection may experience lower limb lymphedema, resulting in physical discomfort and poor quality of life (QOL). Purpose: This study developed and assessed the effectiveness of a clinical guideline for preventing lower limb lymphedema in women with gynecological cancer following surgery. Methods: The guideline was created through the following processes: defining the topic and generating clinical questions by using the PICO process, conducting a systematic literature review and evidence appraisal, drafting the clinical guideline for Preventing Lower Limb Lymphedema in Patients with Gynecological Cancer (CGP-3L-in-GC), performing two rounds of Delphi consensus, and evaluating the clinical guidelines in practice. Subsequently, the guideline was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE). Results: A total of 12 evidence-based papers and one published guideline were retrieved to draft the CGP-3L- in- GC, which was then approved through two rounds of Delphi consensus. Finally, an experiment was performed to test the effectiveness of the CGP-3L- in- GC in practice. The CGP-3L- in- GC was applied to 15 women experimental group, and regular care was applied to 14 women control group. The experimental group had a lower number of mild to severe limb edema cases than did the control group (p = .049). Additionally, the QOL of women in the experimental group significantly improved after implementation of the CGP-3L- in- GC, especially in subjective health (Z = −2.33, p = .02) and physiological domains (Z = −2.0, p = .047). An external evaluation using the AGREE indicated that the GCP-3L-in-GC can be recommended to health care providers who care for women with gynecological cancer following lymph node dissection surgery. Conclusions: Because of the limitations of study time and the numbers of subjects, the CGP-3L-in-GC cannot be proved to significantly decrease the prevalence of lower limb lymphedema. However, health care practitioners can apply the guideline to clinical practice when they treat women with gynecological cancer after surgery.

並列關鍵字

gynecologic cancer ； clinical guideline ； lower limb lymphedema

參考文獻

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