乳腺癌调强放射治疗患者不同时段皮肤损伤的护理效果分析

Skin Injury Nursing at Different Stages in Breast Cancer Patients Receiving IMRT

目的探讨乳腺癌患者调强放射治疗中不同时段皮肤损伤的护理效果。方法将2010年9月—2011年7月入住我院放疗科的乳腺癌患者100例随机分为对照组和治疗组,每组50例。对照组实施常规皮肤护理措施,治疗组针对不同时段的皮肤损伤给予针对性护理:患者接受放射治疗的第一时段给予预防性指导;第二时段给予局部皮肤抗感染处理,增加局部皮肤营养;第三时段给予局部皮肤喷氧、蜂蜜纱布外敷,解除局部皮肤缺氧状态,同时增加局部皮肤营养,促进创面愈合。观察记录两组患者放射性皮肤损伤反应发生的时间、程度,并记录其反应发生时的照射剂量。结果放疗结束时,两组患者放射性皮肤损伤分级比较,差异有统计学意义(u=4.765,P=0.000)。两组患者在<20 Gy照射剂量时皮肤损伤的发生率间差异无统计学意义(P=0.110),但在20～40 Gy和>40 Gy照射剂量时皮肤损伤的发生率间差异有统计学意义(P=0.000)。结论对乳腺癌患者在不同放射治疗时段给予针对性护理,能有效降低患者皮肤损伤程度,推迟损伤出现的时间。

Objective To study the effect of skin injury nursing at different stages in breast cancer patients receiving intensity modulated radiotherapy（IMRT）. Methods A total of 100 breast cancer patients were divided randomly into groups control and study,50 in each.Control group underwent conventional skin nursing,study group were given targeted care based on skin injuries at varying stages.Patients given preventable guidance at the first stage of radiotherapy,local skin anti-infection treatment to increase local skin nutrition at the second stage and local skin oxygen spray and honey gauze to release the hypoxic state of local skin and increase local skin nutrition to promote wound healing at the third stage.The onset time and degree of radiation-induced skin damage response were observed and its reaction irradiation dose recorded. Results There was significant difference in the grading of radiation-induced acute skin injury between two groups after radiotherapy（u=4.765,P=0.000）.There was significant difference in incidence of skin injury at 20 Gy irradiation dose（P=0.110）,but differently at 20~40 Gy and 40 Gy irradiation doses（P=0.000）. Conclusion Targeted nursing for radiation-induced local skin injuries at varying stages of breast cancer radiotherapy is effective in reducing degree of skin injuries and postponing the time of injury occurrence.