分化型甲癌术后首次大剂量^(131)I治疗的护理探讨

Nursing interventions for the postoperative patients with differentiated thyroid cancer having first large dose of iodine-131 thrapy

目的探讨分化型甲癌术后首次大剂量131I治疗的有效护理措施。方法回顾性分析334例分化型甲癌术后首次行大剂量131I治疗患者的临床资料。采取护理措施包括重点加强131I治疗健康教育及心理护理,加强治疗反应护理和放射防护护理。结果本组患者均顺利完成首次大剂量131I治疗,其中颈部残留甲状腺组织首次完全清除率为55.69%(186/334)。对战胜疾病有信心的患者由治疗前的10.78%上升至治疗后的86.53%。治疗后次日2例出现呕吐,半年内63(18.86%)例出现唾液腺功能受损症状,无一例因颈部肿胀导致呼吸困难。医护人员个人放射线剂量检测,测得季度个人剂量当量Hp(10)均<0.3mSv。结论加强系统全面的健康教育、心理护理、治疗反应的护理及放射防护护理,可提高分化型甲癌术后首次大剂量131I治疗的疗效,增强患者战胜疾病的信心,减轻不良反应,提高工作人员辐射防护水平。

Objective To analyze the effective nursing interventions for postoperative patients with dif- ferentiated thyroid cancer received first large dose of iedine-131 therapy. Methods To survey in 334 cases of postoperative patients with differentiated thyroid cancer had iodine-131 treatment were retrospectively stuched. The nursing interventions include health education, psychological nursing care, and the nursing interventions to relieve its side effects and protect against radiation. Results All patients received first iodine-131 therapies successfully, the overall clearance of residual thyroid tissues were 55.69% （186/334）. Confidence in conquerillness were increased from 10.78% （before treatment） to 86.53% （after treatment）. Vomiting occurred in 2 cases at the second day after the treatment, and 18.86% （63/334） patients presented symptoms of impairing of salivary glands within half a year, but no patients presented dyspnoea for swelling of the neck after the therapy. Quarterly individual dose equivalent （Hpl0） of all medical staff involved in the treatment were less than 0.3mSv. Conclu- sion Systemic and comprehensive health education, psychological nursing care, the nursing care to therapeutic reaction and radiation protection can improve the treatment effect of pestoperative patients with differentiated thyroid cancer to iodine-131 therapy, strengthen the confidence of the patients to fighting against disease, alle- viate the adverse reaction, as well as improve the radiation protection to the medical staff.