Post-operative rehabilitation guidance for breast cancer
In order to reduce the occurrence of postoperative complications of breast cancer and prevent the dysfunction of the affected upper limb, the postoperative wound observation, continuous negative pressure drainage and pressure dressing of the wound and functional exercise of the affected upper limb were strengthened, which effectively reduced the occurrence of postoperative complications and basically restored the function of the affected upper limb to normal.
I. Postoperative care and observation of drainage tube
Closely observe the change of condition. The patient was operated under continuous epidural anesthesia and intravenous compound anesthesia, and should be placed in a lying position after the operation and closely monitored for blood pressure, pulse and respiration. After the patient is awake and the vital signs are stable, he/she should be given a semi-recumbent position to facilitate the recovery of respiratory and cardiac function and drainage, and to avoid or reduce the edema of the operated limb. Observe the wound dressing for exudation. Due to the extensive and traumatic nature of radical breast cancer surgery, early localized negative pressure suction or pressure bandaging with bandages or chest straps, or pressure with sandbags to help the skin pieces to adhere, avoiding subcutaneous blood and fluid accumulation. Appropriate postoperative wound pressure dressing is helpful to squeeze out the fluid in the surgical residual cavity, and connect the negative pressure drainage tube. If the negative pressure drainage is not smooth and there is more exudate, it will cause fluid accumulation and flap floating, resulting in serious consequences such as flap ischemia and necrosis. However, attention should be paid to the blood supply (skin color, temperature, pulse, etc.) of the distal limb of the affected side. Therefore, skin changes should be observed once during the 48th postoperative hour. If the skin is cyanotic, accompanied by low skin temperature and indistinct pulse, it indicates that the compression bandage is too tight and the axillary vessels are under pressure, the bandage should be adjusted in time to restore normal blood flow to the affected side; if the bandage or chest band is loose and sliding, the bandage should be re-pressurized to reduce the fluid accumulation in the trauma cavity and make the skin flap or implant flap tightly adhere to the chest wall to facilitate healing. For drainage tube management, nursing staff should squeeze the drainage tube once/0.5h to maintain effective negative pressure to ensure smooth drainage, avoid complications such as slipping, obstruction and falling into the body cavity, and closely observe the color and nature of the drainage fluid and record the drainage flow, the drainage fluid is bloody within 24h after surgery, and the drainage flow generally does not exceed 150ml; if it exceeds, it should be reported to the doctor in time to check whether there is active If it is more than that, it should be reported to the doctor and checked for active bleeding. 24~48h is light blood-like fluid, usually not more than 40ml, and after 72h or if the drainage flow is below 15ml/24h, the tube can be removed. When the drainage tube connected to the negative pressure source encounters active bleeding, the negative pressure suction should be stopped immediately to avoid aggravating the bleeding.
Functional exercise of the affected limb
Modified radical mastectomy for breast cancer requires removal of the affected breast, axilla, subclavian, large and small interstitial lymph nodes and connective tissue. Due to the wide resection area, if functional exercise is not performed in time after surgery, it will cause dysfunction of the affected upper limb, which will affect life and work. The functional exercise after breast cancer surgery can be divided into 3 stages, namely, the bed rest period, the bed activity period and the post-discharge period.
Functional exercise during the bed rest period
After modified radical mastectomy, in order to make the skin heal well and avoid fluid accumulation, a rubber drainage tube should be placed and wrapped with a chest band under pressure after surgery. After returning to the ward, the rubber drainage tube will be connected to the negative pressure suction device, so the patient will be bedridden for 1-2 days after surgery. Due to the obstruction of lymphatic and venous return caused by axillary lymphatic drainage, the affected arm has different degrees of edema and functional impairment. After the operation, the patient should pay attention to the elevation of the affected limb and practice fist clenching and forearm flexion and extension exercises for 5 minutes/time, 3-5 times/day. Place the upper arm above the level of the anterior chest wall when lying down, and for severe swelling, massage with manipulation. The masseur uses both hands to clasp into a ring to elevate the affected limb, from the distal side to the proximal side with a certain pressure push, 3 times / d, 15min / time …… This period should mainly exercise the function of the hand, wrist and elbow joint. You can do finger extension, fist clenching and wrist flexion, elbow flexion and other exercises.
Fourth, the functional exercise of the bedtime activities
After the negative pressure suction tube under the flap is removed, the patient starts to get out of bed until the time of discharge. This period is mainly for shoulder joint exercise. Since the scar tissue near the axillary incision has not yet formed, early exercise can restore the function of deltoid, trapezius and latissimus dorsi muscles as soon as possible. It is an important part of functional exercise of upper limbs after radical breast cancer surgery. Methods of exercise.
(1) 2~4 days after surgery, patients can sit up and start flexing elbow exercise.
(2) 5 days after surgery, after lifting the chest belt that fixes the upper limbs, the patient can practice palm touching the contralateral shoulder and ipsilateral ear.
(3) Remove the incision sutures within 9~10 days after surgery. At this time, you can exercise to elevate the upper limb of the affected limb by flexing and elevating the elbow joint of the affected side and placing the palm of the hand on the contralateral shoulder. Initially, the affected elbow can be supported by the palm of the healthy hand, and the affected upper limb can be gradually raised until it is level with the shoulder.
(4) Fourteen days after surgery, practice placing the palm of the affected hand behind the neck, so that the affected upper limb is gradually raised to the position where the patient’s head is lowered from the beginning of the exercise to the position where the head is raised and the chest is raised, and then the affected palm can cross the top of the head and touch the contralateral ear. In order to expand the range of motion of the shoulder joint, you can also do wall-holding exercises at this time to strengthen the function of raising the upper limb on the affected side.
V. Exercise of upper limb function after discharge
After the patient is discharged from the hospital, he should continue to insist on the functional exercise of the affected limb. The above exercises can be repeated, especially the exercise of raising the upper limb by holding the wall, which can gradually restore the range of motion of the upper limb and shoulder joint to normal. In order to further make the movements coordinated, natural and easy, the following functional exercises can also be performed.
(1) Upper limb rotation exercise: First, the upper limb of the affected limb should be naturally lowered, with the five fingers straight and together. Gradually raise the affected limb to the highest point from the front of the body, and then gradually return to the original position from the outside of the body. Note that the upper limb should be straightened as much as possible when lifting, avoid bending, the movement should be consistent, or exercise from the opposite direction.
(2) Upper limb posterior extension exercise: patients should keep their heads up and chest up. In addition, patients can also develop lifting, pulling
In addition, patients can also develop various weight-bearing exercises of lifting, pulling, lifting, lifting and objects in daily life to enhance the strength of the affected upper limb and make its function completely normalized. The above exercises should be performed 1~3 times a day, 30min each time to avoid overexertion, and should be done gradually and appropriately. For patients with special conditions, exercise time should be reduced or delayed as appropriate, but do not stop practicing.
VI. Postoperative precautions.
Due to inappropriate exercise or inattention to protection of the affected limb in daily life, it is easy to cause serious edema of the affected limb.
(1) Avoid intravenous infusion on the affected side as much as possible.
(2) Don’t do flinging and stretching of the affected limb.
(3) Do not lift heavy objects on the affected side.
(4) Do not twist and turn clothes on the affected side.
(5) Do not play strenuous sports such as badminton on the affected side.