Lymphedema: a therapeutic approach in the treatment and rehabilitation of cancer patients.
Lymphedema: a therapeutic approach in the treatment and rehabilitation of cancer patients.
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DOI：
10.1097/phm.0b013e31820be160
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发表时间：
2011-05-01
影响因子：
3
通讯作者：
Fialka-Moser, Veronika
中科院分区：
文献类型：
--
作者：
Korpan, Marta I;Crevenna, Richard;Fialka-Moser, Veronika
淋巴水肿疗法在最近的过去已经有了许多名字，被称为复杂的充血疗法，复杂的物理疗法或充血淋巴疗法等。水肿治疗分为两个阶段：急性“强化”阶段和维持阶段。在治疗的急性期，个体通常用医用短拉伸压缩绷带包裹;接受治疗性锻炼、皮肤护理和教育;并由经过专门训练的物理治疗师或医疗保健专业人员进行手动淋巴引流。在维持阶段，目标是使患者能够在白天穿着合适的梯度压力服装并进行加压包扎（或作为绷带的替代品的装置），以保持良好的皮肤护理，继续进行治疗性锻炼，并对具有受损淋巴管的身体区域自行进行手动淋巴引流（或使用可进行手动淋巴引流的机械装置）。每个阶段中各种成分的有效性以及患者的动机和依从性都不同。需要进一步的随机试验来确定复杂的缓解充血疗法中哪种成分或成分组合最有效。建议患者不仅要保持身体活动，因为它对健康有许多好处，而且还可以促进肌肉泵送，使淋巴液在全身流动。对水肿发生的一些病理生理机制的认识正在增加，并且有可能在未来通过分子疗法增强目前治疗水肿的模式。
Lymphedema therapy has gone by many names in the recent past, being referred to as complex decongestive therapy, complex physical therapy, or decongestive lymphatic therapy, among others. There are two phases of lymphedema treatment: the acute "intensive" phase and the maintenance phase. In the acute phase of treatment, the individual is typically wrapped with medical short-stretch compression bandages; receives a therapeutic exercise routine, skin care, and education; and undergoes manual lymphatic drainage by a specially trained physical therapist or healthcare professional. In the maintenance phase, the goals are for the individual to be able to wear a well-fitted appropriate gradient pressure garment during the day and compression bandaging (or a device that serves as an alternative to bandaging) at night, to maintain good skin care, to continue with therapeutic exercise, and to self-perform manual lymphatic drainage (or use a mechanical device that can perform manual lymphatic drainage) for the area of the body with impaired lymphatics. The effectiveness of the various components in each phase, as well as the motivation and compliance of the patient, differs. Further randomized trials are required to determine which component or combination of components in complex decongestive therapy works most effectively. It is recommended for patients not only to maintain physical activity for its many health benefits but also to facilitate muscle pumping to move lymphatic fluid throughout the body. Knowledge of some of the pathophysiologic mechanisms involved in the development of lymphedema is increasing, and it is possible that current modes of treatment of lymphedema will be augmented by molecular therapies in the future.