护理干预对鼻咽癌放疗患者放射性口腔炎影响的系统评价

A systematic review of nursing intervention on nasopharyngeal carcinoma patients with radiation-induced oral mucositis treated with radiotherapy

目的：系统评价国内所有发表的有关护理干预对鼻咽癌放疗患者放射性口腔炎影响的随机对照试验。方法计算机检索CBM、VIP、CNKI等数据库,并辅助手工检索和引文检索,全面获取相关内容资料。根据纳入、排除标准,由两名研究者独立筛选文献、进行方法学质量评价和资料提取。采用RevMan 5.0软件进行meta分析。结果共纳入9个随机对照试验,共1113例患者。 meta分析结果显示：护理干预可以降低鼻咽癌患者放射治疗初期（2~4周）、中期（4周左右）、末期（≥6周）重度口腔黏膜炎的发生率,合并效应值分别为[ RR=0.36,95%CI（0.15,0.88）,P=0.02]、[RR=0.45,95%CI（0.33,0.61）,P〈0.00001]、[RR=0.47,95%CI（0.39,0.56）,P〈0.00001],差异均有统计学意义。结论护理人员对鼻咽癌放疗患者采取有针对性的护理干预,能显著降低放射性口腔黏膜炎的发生率,延缓重度黏膜反应出现的时间。但由于纳入研究的文献质量不高、护理干预方式有差异及meta分析自身的局限性,尚需更多高质量的研究以增加论证强度。

Objective To systematically review the randomly-chosen documents published in China about the influence of nursing intervention on NPC patients with radioactive stomatitis treated with radiotherapy. Methods CBM, VIP and CNKI database were all researched on computer combined with auxiliary manual retrieval and citation retrieval to get a comprehensive related content materials. Two researchers conducted the literature screening, the quality evalua-tion of methodologically and the extraction of materials according to inclusion and exclusion criteria independent-ly. RevMan 5. 0 software was adopted to make meta-analysis of all data. Results Nine randomly controlled trials with 1 113 patients were included. Meta analysis results revealed that nursing intervention could reduce the incidence of se-vere oral mucositis of NPC patients at their initial （2 to 4 weeks）, medium （4 weeks or so）, and terminal （equal or greater than 6 weeks） stage of radiotherapy. The merger effect value were respectively [RR=0. 36, 95%CI （0. 15, 0. 88 ） , P=0. 02 ] , [ RR=0. 45 , 95%CI （ 0. 33 , 0. 61 ） , P〈0. 000 01 ] and [ RR=0. 47 , 95%CI （ 0. 39 , 0. 56 ） , P〈0. 000 01 ] , and the differences were statistically significant. Conclusion Targeted nursing intervention on NPC patients undergoing radiotherapy can significantly reduce the incidence of radiation-induced oral mucositis and de-lay the occurances of severe mucositis. But due to low quality of the included studies, the differences in terms of nursing intervention and the limitations of meta analysis itself, more high quality research was needed in order to increase the in-tensity of argument.