急性白血病化疗后合并口腔粘膜炎的综合治疗

Comprehensive treatment for chemotherapy-induced oral mucositis complicated with acute leukemia

目的：探讨急性白血病（acute leukemia AL）化疗后合并口腔粘膜炎感染相关因素及临床治疗方法。方法：对我院2004年5月～2006年5月住院的212例AL化疗后出现口腔粘膜炎（oraL mucositis OM）的病例进行临床资料分析，在给予全身支持疗法的基础上，使用中药紫草油与氟康唑、利多卡因的混匀液交替进行局部治疗。结果：AL化疗后并发OM占65％，发病率较高，发病率和骨髓受抑、粒细胞缺乏程度呈正相关。积极控制细菌、霉菌混合感染，应用人血丙种球蛋白等提高免疫力，局部紫草油加氟康唑250ml（或者伊曲康唑0．25g配置成250ml溶液代替氟康唑）＋2％利多卡因溶液5ml的交替涂敷、漱口治疗，与常规给药对比有显著疗效（P〈0．01）。结论：急性白血病（AL）口腔粘膜炎感染相关因素和机体的免疫力、化疗强度、粒细胞缺乏程度相关，紫草油与氟康唑＋利多卡因混匀液的交替治疗效果较好。

Objective： To explore the factors and therapeutics for chemotherapy-induced oral mucositis （OM） complicated with acute leukemia （AL）. Methods：This study was based on analyzing clinical data of 212 in-patients with chemotherapy-induced OM complicated with AL for the past two years. Regional therapy, as well as supportive treatment, was applied using traditional Chinese medicine ZiCao oil plus butoconazole-lidocaine solution alternatively. Results：The incidence of chemotherapy-induced OM complicated with AL is about 65%, related highly with arrest of bone marrow and agranulocytosis. The emergence of bacterial, mycotic, and viral infections should be treated actively. Human immunoglobulin was used to strengthen body immunity and regional coating with ZiCao oil or gargling with butoconazole 250ml （ or itraconazole 0. 25g in 250 ml in place of butoconazole ）, plus 2% lidocaine solution were alternatively applied. Significant effectiveness was obtained compared with normal therapy （ P 〈 0. 05 ）. Conclusion： Chemotherapy-induced oral mucositis complicated with AL is highly related to immunity, intensity of chemotherapy and severity of agranulocytosis. This study suggests the healing effect of ZiCao oil plus butoconazole-lidocaine solution.