Lymphatic drainage, manual, physical therapy
淋巴引流、手动、物理治疗Revised: May 20, 2024 修订日期：2024 年 5 月 20 日
Introduction
介绍
The lymphatic network is a one-way path that transports interstitial fluid in the connective tissue spaces to the circulatory system through lymph vessels and nodes. When something compromises the lymphatic system, the soft tissues retain this interstitial fluid, and water (the main component of this fluid), protein, and cellular metabolites accumulate in the tissues, causing edema.
淋巴网络是一条单向路径，通过淋巴管和淋巴结将结缔组织间隙中的间质液输送到循环系统。当某些东西损害淋巴系统时，软组织会保留这种间质液，水（这种液体的主要成分）、蛋白质和细胞代谢物会在组织中积聚，导致水肿。
Because the lymphatic vessels are located just beneath the epidermis of the skin and are less than 1 mm in diameter on average, it's possible to facilitate lymph movement through gentle external pressure. Manual lymphatic drainage involves the use of very light, massaging pressure strokes (effleurage) to stretch the skin in a specific manner to mobilize lymph flow.12 This therapeutic form of soft-tissue mobilization reduces lymphedema and enhances dilation and contractility of lymphatic vessels, promoting drainage from distal to proximal areas within the superficial and deep systems of the lymphatic vascular network. Effective manual lymphatic techniques require very little pressure. (See Lymphatic drainage techniques.)
由于淋巴管位于皮肤表皮正下方，平均直径小于 1 毫米，因此可以通过温和的外部压力促进淋巴运动。手动淋巴引流涉及使用非常轻的按摩压力推流（轻扫），以特定方式拉伸皮肤以动员淋巴液流。12 这种治疗形式的软组织动员可减轻淋巴水肿并增强淋巴管的扩张和收缩，促进淋巴管网络浅层和深部系统内从远端到近端区域的引流。有效的手动淋巴技术需要的压力非常小。（见淋巴引流技术。
To maximize the effectiveness of treatment, manual lymphatic drainage should be performed on bare skin with no oils or lotions. Treatment starts centrally at the neck and trunk to open and clear out the main lymphatic pathways and promote drainage from distal areas. Stimulation should begin with the regions of the body where lymph nodes are most prevalent (the neck, axilla, and groin) so that they can receive fluid from the affected limb.
为了最大限度地提高治疗效果，应在裸露的皮肤上进行手动淋巴引流，不要使用油或乳液。治疗从颈部和躯干中央开始，以打开和清除主要淋巴通路，并促进远端区域的引流。刺激应从淋巴结最普遍的身体区域（颈部、腋窝和腹股沟）开始，以便它们可以从患肢接收液体。
| LYMPHATIC DRAINAGE TECHNIQUES 淋巴引流技术 |
Therapists who have received specialized training use several techniques when performing manual lymphatic drainage. However, all techniques are variations on the basic motion of a straight stretch combined with a small lateral movement, known as stationary circles.3 Very light pressure and slow, rhythmic movement help gently stretch the skin toward the proximal lymph nodes. The pressure phase promotes fluid to move in the desired direction of drainage; a pressure-free relaxation phase follows. Strokes should occur at a rate of one per second, performed five to seven times per area.4 To apply stationary circles, place your fingers flat on the patient's skin and then lightly stretch and move the skin in a circular motion. End the circle in the direction of lymph flow, toward the proximal lymph node. In the zero-pressure relaxation phase of the stroke, maintain skin contact but allow the skin to spring back naturally.5 Use pump and scoop techniques on rounded areas of an extremity. To apply these techniques, place the web space of your hand at a right angle to the affected limb, with the thumb and index finger contacting the skin. Exert gentle pressure using wrist flexion and extension.3 You can perform rotary techniques on flat surfaces of the trunk by using your flat palm and fingers to gently press the skin while your thumb adducts. |
The only absolute contraindication for manual lymphatic drainage is neoplasia in the affected limb.4 Relative contraindications include acute infection, cellulitis, and inflammation in the affected limb because manual lymphatic drainage can spread infection or exacerbate signs and symptoms. Other relative contraindications include varicosis, hemophilia, anticoagulant therapy, and conditions that affect the vascular system, such as acute deep vein thrombosis, significant heart failure, and hemorrhage.1
手动淋巴引流的唯一绝对禁忌证是患肢的瘤变。4 相对禁忌证包括患肢急性感染、蜂窝织炎和炎症，因为手动淋巴引流可传播感染或加剧体征和症状。其他相对禁忌证包括静脉曲张、血友病、抗凝治疗和影响血管系统的疾病，例如急性深静脉血栓形成、严重心力衰竭和出血。1
Equipment
设备
Bed or plinth 床或底座
Gloves 手套
Sheet or drape 片材或悬垂
Tape measure 卷尺
Optional: compression garment, low-stretch elastic sleeve, other personal protective equipment, stocking
可选：压缩衣、低弹性袖套、其他个人防护装备、长袜
Preparation of Equipment
设备准备
Inspect all equipment and supplies. If a product is expired, is defective, or has compromised integrity, remove it from patient use, label it as expired or defective, and report the expiration or defect as directed by your facility. If you're applying a low-stretch elastic sleeve, stocking, or compression garment, ensure that it is the appropriate size and follow the manufacturer's recommendations for use and care.
检查所有设备和用品。如果商品已过期、有缺陷或完整性受损，请将其从患者使用中移除，将其标记为已过期或有缺陷，并按照您的设施的指示报告过期或缺陷。如果您要使用低弹性袖套、长袜或压缩服，请确保其尺寸合适，并遵循制造商的使用和护理建议。
Implementation
实现
Verify the practitioner's order.
验证 Practitioner 的医嘱。Review the patient's medical record for any relative or absolute contraindications to therapy.
查看患者的病历，了解治疗的任何相对或绝对禁忌证。Gather and prepare the necessary equipment and supplies.
收集并准备必要的设备和用品。Perform hand hygiene.67891011
保持手部卫生。6789 1011Confirm the patient's identity using at least two patient identifiers.12
使用至少两个患者标识符确认患者的身份。12Provide privacy.13141516
提供隐私。票价：13141516Introduce yourself to the patient and explain your role.
向患者介绍自己并解释您的角色。Evaluate the patient before treatment. Include a detailed history, clinical examination, skin inspection and palpation, and limb circumferential girth measurements.17 (See the "Circumferential girth measurement, physical therapy" procedure.)
治疗前对患者进行评估。包括详细的病史、临床检查、皮肤检查和触诊以及肢体周长测量。17（参见 “周长测量，物理治疗”程序。Explain the procedure to the patient and family according to their individual communication and learning needs to increase their understanding, allay their fears, and enhance cooperation.18
根据患者和家属的个人沟通和学习需求，向他们解释程序，以增加他们的理解，减轻他们的恐惧，并加强合作。18Tell the patient that you must perform manual lymphatic drainage treatments on bare skin and that the procedure requires clothing removal from the area of the body that requires treatment.17
告诉患者，您必须对裸露的皮肤进行手动淋巴引流治疗，并且该手术需要从需要治疗的身体部位脱掉衣服。17Perform hand hygiene.67891011
保持手部卫生。6789 1011Put on gloves and, as needed, other personal protective equipment to comply with standard precautions.192021
戴上手套，并根据需要佩戴其他个人防护装备，以符合标准预防措施。192021Assist the patient with clothing removal, if necessary.
如有必要，协助患者脱掉衣服。If possible, help the patient into the supine position because this position promotes uninhibited lymphatic flow.4
如果可能，帮助患者进入仰卧位，因为这个姿势会促进不受抑制的淋巴流动。4Drape the patient for privacy and comfort.
为患者披上窗帘，以保护隐私和舒适。Perform the treatment sequence at a rate of one stroke per second, repeating it five to seven times in each area.
以每秒 1 次冲程的速度执行治疗序列，在每个区域重复 5 到 7 次。
For upper extremity treatment
用于上肢治疗
Perform stationary circles at the proximal lymph nodes of the neck.
在颈部近端淋巴结做固定圆圈。Use effleurage and soft strokes along the affected limb in the direction of normal lymphatic discharge.
沿着患肢按照正常淋巴分泌物的方向轻柔地抚摸。Perform stationary circles at the axilla.
在腋窝做静止圆圈。Perform stationary circles medially up the proximal limb from the elbow to the axilla.
从肘部到腋窝，在近端肢内侧做固定圆圈。Pump the lateral upper arm in a distal-to-proximal direction.
沿远端到近端方向泵动外侧上臂。Perform stationary circles at the cubital fossa.
在肘窝做静止圆圈。Pump or perform stationary circles at the forearm in a distal-to-proximal direction.
在前臂沿远端到近端方向泵动或进行静止圆圈。Perform stationary circles at the dorsum of the wrist, hand, and fingers and then on the palm.
在手腕、手和手指的背侧做固定圆圈，然后在手掌上做固定圆圈。Use final effleurage and soft strokes along the affected limb in the direction of normal lymphatic drainage.
沿着患肢按照正常淋巴引流的方向进行最后的轻抚和轻柔的抚摸。
For lower extremity treatment
用于下肢治疗
Perform stationary circles at the groin.
在腹股沟处做固定圆圈。Use effleurage and soft strokes along the affected limb in the direction of normal lymphatic discharge.
沿着患肢按照正常淋巴分泌物的方向轻柔地抚摸。Perform stationary circles medially up the proximal limb from the knee to the groin.
从膝盖到腹股沟的近端肢内侧做固定圆圈。Pump the anterolateral thigh in a distal-to-proximal direction.
向远端到近端方向泵送大腿前外侧。Gently lift the knee, as necessary, to gain access to the popliteal fossa. Perform stationary circles at the popliteal fossa.
必要时轻轻抬起膝盖，以进入腘窝。在腘窝做静止圈。Pump or perform stationary circles at the anterior lower leg and calf in a distal-to-proximal direction.
在小腿前部和小腿沿远端到近端方向进行泵动或进行静止圆圈。Perform stationary circles at the foot and toes and then the ankle.
在脚和脚趾处做静止圆圈，然后在脚踝处做静止圆圈。Use final effleurage and soft strokes along the affected limb in the direction of normal lymphatic drainage.
沿着患肢按照正常淋巴引流的方向进行最后的轻抚和轻柔的抚摸。
Completing the procedure 完成过程
At the end of the session, apply a low-stretch elastic sleeve, stocking, or compression garment, as ordered, to maintain edema reduction.22
在治疗结束时，按照要求使用低弹性袖子、长袜或压缩服，以保持水肿减少。22Assist the patient with dressing, if necessary.
如有必要，协助患者穿衣。Make sure that the patient's call light and necessary personal items are within reach to promote patient safety.
确保患者的呼叫指示灯和必要的个人物品触手可及，以促进患者安全。Remove and discard your gloves and, if worn, other personal protective equipment.19
取下并丢弃您的手套，如果佩戴了其他个人防护装备。19Perform hand hygiene.67891011
保持手部卫生。6789 1011Document the procedure.23242526
记录过程。票价：23242526
Special Considerations
特别注意事项
If ordered, elevate the affected limb after applying a low-stretch elastic sleeve, stocking, or compression garment to maintain edema reduction after treatment.27
如果需要，在使用低弹性袖套、长袜或压缩服后抬高患肢，以保持治疗后的水肿减轻。27
Patient Teaching
患者教学
Instruct the patient and family or caregiver about proper elevation positions that promote lymphatic flow. Demonstrate the correct application and removal of a low-stretch elastic sleeve, stocking, or compression garment, as ordered. Show how to inspect the skin to maintain skin integrity. Teach about signs and symptoms of restricted vascular circulation, including cyanosis, pain, and increased swelling, which can result from wearing compression garments, and tell the patient when to notify the practitioner.
指导患者及其家属或照护者如何正确地抬高促进淋巴流动的姿势。展示如何按照要求正确使用和脱下低弹性袖子、长袜或紧身衣。展示如何检查皮肤以保持皮肤完整性。传授血管循环受限的体征和症状，包括发绀、疼痛和肿胀加剧，这些症状可能由穿着紧身衣引起，并告诉患者何时通知医生。
Complications
并发症
Complications associated with manual lymphatic drainage may include:
与手动淋巴引流相关的并发症可能包括：
lymphatic vessel collapse (from overly aggressive performance of manual lymphatic drainage).
淋巴管塌陷（由于手动淋巴引流的过度激进）。
Documentation
文档
Documentation associated with manual lymphatic drainage includes:
与手动淋巴引流相关的文件包括：
date and time of the procedure
手术日期和时间skin inspection and palpation findings
皮肤检查和触诊结果region of treatment 治疗区域
limb circumferential girth measurements before treatment
治疗前肢体周长测量duration of the treatment
治疗持续时间type and number of manual lymphatic drainage strokes used
使用的手动淋巴引流冲程的类型和次数response to treatment 对治疗的反应
teaching provided to the patient and family (if applicable)
为患者和家属提供教学（如适用）understanding of that teaching
对该教义的理解follow-up teaching needed.
需要后续教学。
Related Lexicomp and UpToDate Patient Teaching Handouts
相关Lexicomp和UpToDate患者教学讲义
Massage 按摩
References
引用
(Rating System for the Hierarchy of Evidence for Intervention/Treatment Questions)
（干预/治疗问题证据层次结构的评级系统）
Rockson, S. G. (2008). Diagnosis and management of lymphatic vascular disease. Journal of the American College of Cardiology, 52(10), 799–806. Retrieved April 2024 from https://www.sciencedirect.com/science/article/pii/S0735109708021001?via%3Dihub(Level VII)
罗克森，SG（2008 年）。淋巴管疾病的诊断和管理。美国心脏病学会杂志，52（10），799-806。2024 年 4 月从 https://www.sciencedirect.com/science/article/pii/S0735109708021001?via%3Dihub（VII 级）检索Abstract 抽象 | Complete Reference
|完整参考| Full Text |全文 Hillegass, E. (2022). Essentials of cardiopulmonary physical therapy (5th ed.). Elsevier.
希勒加斯，E.（2022 年）。心肺物理治疗要点（第 5 版）。爱思唯尔。Wittlinger, H., et al. (2019). Dr. Vodder's manual lymph drainage: A practical guide (2nd ed.). Thieme.
Wittlinger， H. 等人（2019 年）。Vodder 博士的手动淋巴引流：实用指南（第 2 版）。蒂埃姆。Executive Committee of the International Society of Lymphology. (2020). The diagnosis and treatment of peripheral lymphedema: 2020 consensus document of the International Society of Lymphology. Lymphology, 53(2020), 3–19. Retrieved April 2024 from https://journals.librarypublishing.arizona.edu/lymph/article/4649/galley/4692/download/ (Level VII)
国际淋巴学会执行委员会。（2020）. 外周淋巴水肿的诊断和治疗：国际淋巴学会 2020 年共识文件。淋巴学， 53（2020）， 3-19。2024 年 4 月从 https://journals.librarypublishing.arizona.edu/lymph/article/4649/galley/4692/download/ 检索（VII 级）
