缓和医疗理念在头颈部肿瘤患者放疗期间的应用探索

Palliative care to patients with head and neck cancer during radiotherapy

目的探讨缓和医疗理念应用于头颈部肿瘤放疗患者的作用和意义。方法选择2017年11月-2018年11月解放军总医院第一医学中心放疗科收治的60例头颈部肿瘤患者,随机分为研究组和对照组,每组各30例。对照组采用常规放疗管理,研究组采用缓和医疗理念照护。比较两组患者的急性放射不良反应、生活质量(EORTC QLQ-C30量表)和营养状况。结果两组患者基线资料差异无统计学意义。放疗后研究组2级以上口腔黏膜炎[5例(16.67%)vs 12例(40.00%)]和放射性皮炎[1例(3.33%)vs 5例(16.67%)]病例均少于对照组(P均<0.05);研究组Ⅲ~Ⅳ级骨髓抑制5例,少于对照组的13例(P=0.024);研究组低蛋白血症患者2例,对照组10例(P=0.010)。放疗后,研究组的EORTC QLQ-C30评分中躯体功能、情绪功能及总健康评分高于对照组(P<0.05),而食欲丧失、疲乏、疼痛的症状评分低于对照组(P<0.05)。放疗后,研究组体质量丢失≥5%患者15例,发生重度营养不良者12例,而对照组分别为25例和24例,两组差异均有统计学意义(P<0.05)。结论缓和医疗理念应用于头颈部肿瘤放疗患者,能够减轻放疗不良反应,改善生活质量和营养状况。

Objective To explore the effect and significance of palliative care in patients with head and neck cancer during radiotherapy.Methods A total of 60 patients with head and neck cancer in the department of radiotherapy of the first medical center of Chinese PLA General Hospital from November 2017 to November 2018 were randomly divided into study group and control group.The control group was treated with conventional radiotherapy care,and the study group was treated comprehensive treatment plan under the guidence of palliative care concept.The acute radiation adverse reactions,quality of life and nutritional status of the two groups were compared.Results There was no significant difference in baseline data between the two groups(all P>0.05).The incidences of severe oral mucositis(≥gradeⅡ)(5[16.67%]vs 12[40.00%]),and severe radiodermatitis(≥gradeⅡ)(1[3.33%]vs5[16.67%])were significantly lower in study group than those of control group.Five patients had gradeⅢ-Ⅳmyelosuppression in the study group,which was significant less than 13 cases in the control group(P=0.024).Hypoproteinemia was found in two patients in the study group and 10 patients in the control group after radiotherapy,with significant difference(P=0.010).No significant difference was found in the quality of life between the two groups before radiotherapy.After radiotherapy,the scores of physical function,emotional function and global quality of life in the study group were significantly higher than those in the control group(all P<0.05),while the symptom scores of loss of appetite,fatigue and pain in the study group were lower than those in the control group(P<0.05).Fifteen cases had weight loss≥5%and 12 cases had severe malnutrition in the study group,while the number was 25 cases and 24 cases in the control group,respectively,with significant difference(P<0.05).Conclusion The application of palliative care during radiotherapy for head and neck cancer patients can reduce the adverse reactions of radiotherapy,improve the quality of life and nutritional status.