Abstract: Objective　To summarize and evaluate the best evidence of early postoperative functional exercise in breast cancer patients.Methods　In June 2017，clinical practice guidelines，systematic reviews and related evidence-based resources pertaining to early postoperative functional exercise in breast cancer were retrieved through the Chinese databases，English databases and guideline websites by computer.The publication-data limit was set by May 2017.The literatures screened were read and the literature quality was assessed by two investigators.All data needed were extracted from the literatures that met the quality.Results　Nineteen articles were enrolled，including three clinical practice guidelines，nine systematic reviews，and seven related evidence-based resources.The three clinical practice guidelines mainly included principles of functional exercises，forms of instruction，the content of functional exercises，standard requirements and considerations.The 16 systematic reviews and related evidence-based resources mainly included principles of functional exercises，forms of instruction，functions of educators，the content of exercise，effect evaluation of exercise，parameters of exercise and the evaluating indicator.It was suggested that professionals should follow the principle of gradual progress，combined with paper-based materials to guide patients.Preoperative assessment of bilateral upper extremity function should be performed.1-2 days after the operation，the shoulder joint should remain motionless，and activities of fingers，wrists and elbow joints be performed.The time of shoulder joint activity is controversial，so professionals should weigh the pros and cons，according to the patients' situation （such as drainage，wound healing，or subcutaneous effusion） to guide patients with shoulder joint activity at their discretion.If the patient has the factors that affect wound healing and drainage，one week of functional exercise can be delayed （9-10 days after the operation）．Conclusion　Evidence-based exercise instruction projects have not been found so far in China.Investigators should propose evidence-based guidelines based on the latest best evidence of early functional exercise，clinical context of care，the patient's needs and preferences and professional judgment.

Key words: Breast neoplasms, Postoperative complications, Exercise, Evidence-based medicine

摘要： 目的　评价总结乳腺癌患者术后早期功能锻炼的最佳证据。方法　2017年6月，通过计算机检索各中、英文数据库及指南网站关于乳腺癌术后早期功能锻炼相关临床实践指南、系统评价及相关循证资源。数据库时间限制为：建库至2017年5月。由两名研究者对文献进行筛选和质量评价，对符合质量标准的文献进行证据提取及内容分析。结果　共纳入19篇文献，其中临床实践指南3篇，系统评价9篇，其他循证资源7篇。纳入的3篇临床实践指南的推荐意见和应用说明的相关内容主要包括功能锻炼的原则、指导形式、功能锻炼的内容、达标要求、注意事项等5项，纳入的16篇系统评价及相关循证资源的推荐意见和应用说明的相关内容主要包括功能锻炼的原则、指导形式、教育者、功能锻炼的内容、功能锻炼效果评价、功能锻炼参数、评价指标等7项。建议专业人员应在循序渐进的原则下，结合纸质材料指导患者进行早期功能锻炼：术前应进行双侧上肢功能的评估，术后1~2 d保持肩关节静止不动，进行手指、手腕、肘关节的活动；肩关节何时锻炼存在争议，专业人员应该权衡利弊，根据患者自身情况（如引流量、创口愈合情况、皮下积液等）谨慎地指导患者进行肩关节活动，如果患者存在影响创口愈合和引流的因素，可以推迟功能锻炼1周（即术后9~10 d）。结论　国内尚未发现基于循证的科学性规范化的功能锻炼指导方案，研究人员应在术后早期功能锻炼最新最佳证据、提供照护的临床情境、患者的要求和偏好、专业人员的判断的基础上构建循证性的指导方案。

关键词: 乳腺肿瘤, 手术后并发症, 功能锻炼, 循证医学