艾灸療法能否改善乳癌相關淋巴水腫病人之腫脹與臂圍

背景：乳癌相關淋巴水腫會衝擊乳癌存活者的身體功能、心理健康及生活品質，臨床實務會運用手動淋巴引流、身體運動及間歇性充氣加壓治療改善乳癌相關淋巴水腫。目的：基於艾灸療法能溫經通絡及調暢氣血，本文運用實證手法探討艾灸療法能否改善乳癌相關淋巴水腫病人之腫脹與臂圍。方法：運用PIO聚焦於臨床問題，包括P「乳癌及淋巴水腫」、I「艾灸療法」及O「腫脹及臂圍」，經搜尋PubMed、Embase、Medline、CINHAL、Cochrane Library、ProQuest Health and Medical Collection華藝線上圖書館及中國知網期刊數據庫等電子資料庫，初步檢索共410篇文獻，依據納入及排除條件，納入系統性文獻回顧及統合分析文章一篇，以CASP系統性文獻回顧檢核表進行實證評讀。結果：此篇系統性文獻回顧與統合分析文章，根據牛津實證醫學中心的證據等級評定為第一等級，建議強度評估、發展與評價分級評核系統評定為非常低。統合分析結果顯示艾灸療法與氣壓循環驅動壓力療法對改善臂圍有相似之成效（平均偏差：0.66、95%信賴區間：-2.63至1.31、p值=0.51），相較於氣壓循環驅動壓力療法，艾灸療法能顯著改善主觀的腫脹程度（平均偏差=-0.51、95%信賴區間=-0.85至-0.17、p值=.003）。結論：艾灸療法對改善乳癌相關淋巴水腫病人之腫脹與臂圍具有成效，建議未來需有更多嚴謹設計與高品質的隨機控制試驗來驗證艾灸療法改善乳癌病人淋巴水腫之成效。

關鍵字

艾灸療法；乳癌；淋巴水腫；腫脹；臂圍

並列摘要

Background: breast cancer related lymphedema (BCRL), which impacts on breast cancer survivals' physical function, psychological wellbeing, and quality of life. Manual lymphatic drainage, physical exercise, and intermittent pneumatic compression were applied for improving BCRL in clinical practice. Purpose: according to moxibustion can warm and active meridian, and harmonize qi and blood, this article applied evidence-based approach to explore whether moxibustion can improve the swelling and arm circumference in patients with BCRL. Methods: population, intervention, and outcome (PIO) was used to focus the clinical problem, including: P: "breast cancer" and "lymphedema"; I: "moxibustion"; O: "swelling" and "arm circumference". The PubMed, Embase, Medline, CINHAL, Cochrane Library, ProQuest Health and Medical Collection, Airiti Library, and CNKI Journal Database were searched, and a total of 410 articles were initially retrieved from the electronic database. According to inclusion and exclusion criteria, one systematic review and meta-analysis were included, and using the Critical Appraisal Skills Program (CASP) systematic review checklist for evidence-based appraisal. Results: this systematic review and meta-analysis article was graded as level of evidence 1 based on Oxford Centre for Evidence-based Medicine level of evidence and was rated as very low quality of evidence based on Grading of Recommendations Assessment, Development and Evaluation (GRADE). The result of this meta-analysis showed that moxibustion and pneumatic circulation driven pressure therapy have similar effects on improving arm circumference (mean deviation = 0.66, 95% confidence interval = -2.63~1.31, p = 0.51). Furthermore, moxibustion revealed significant subjective improvement in swelling as compared to pneumatic circulation driven pressure therapy (mean deviation =-0.51, 95% confidence interval = -0.85~0.17, p = 0.003). Conclusion: Moxibustion is effective for improving swelling and arm circumference in patients with breast cancer-related lymphedema. More rigorously designed and high-quality randomized controlled trial in the future to verify the effect of moxibustion for improving lymphedema in breast cancer patients is warranted.

並列關鍵字

moxibustion ； breast cancer ； lymphedema ； swelling ； arm circumference

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