集束化口腔护理方案在防治鼻咽癌放化疗患者口腔黏膜炎中的应用

Study on application of bundles on prevention and treatment of oral mucositis caused by chemoradiotherapy for patients with nasopharyngeal carcinoma

目的 探讨和研究集束化口腔护理方案防治鼻咽癌患者放化疗所致口腔黏膜炎的效果.方法 选择2014年6-12月符合入选标准的40例患者作为对照组,采用常规护理;选择2015年1-6月符合入选标准的40例患者作为观察组,运用已应用循证方法制订的＆quot;鼻咽癌同期放化疗患者集束化口腔护理方案＆quot;进行管理.结果 放疗21、28、33次时,观察组患者的口腔黏膜炎0、Ⅰ、Ⅱ、Ⅲ、Ⅳ度的例数分别为8、25、7、0、0例;3、11、24、2、0例;0、19、13、6、2例;均低于对照组的0、31、6、3、0例;0、18、11、10、1例;0、9、17、9、5例;2组的差异均有统计学意义（Z=-4.440、-3.441、-2.232,P〈0.05或0.01）.放疗21、28、33次时,观察组患者的口咽部疼痛的程度0、1、2、3级分别为4、31、5、0例;2、22、14、2例;0、26、12、2例;均轻于对照组的1、22、16、1例;0、10、23、7例;0、10、17、13例;2组的差异均有统计学意义（Z=-3.137、-3.326、-3.518,P〈0.01）.放疗28、33次时,观察组焦虑自评量表评分分别为（56.76±3.19）、（58.72±5.41）分,均小于对照组的（60.58±2.46）、（63.42±4.97）分,差异有统计学意义（t=11.746、10.561,P〈0.01）.放疗33次时,观察组抑郁自评量表得分（60.56±3.73）分,低于对照组的（63.43±4.77）分,差异有统计学意义（t=-4.983,P〈0.01）.观察组放疗33次时患者的生命质量量表中吞咽、感觉、社交进食、口干、唾液黏稠、感觉生病症状评分低于对照组,差异均有统计学意义（t=-3.873-5.130,P〈0.05或0.01）.结论 该集束化口腔护理方案能够有效防治鼻咽癌患者放化疗所致口腔黏膜炎的发生,在一定程度上减轻和缓解患者口咽部疼痛和焦虑、抑郁状态,提高生命质量.

Objective To explore and study the effect of bundles on prevention and treatment of oral mucositis caused by chemoradiotherapy for patients with nasopharyngeal carcinoma. Methods A total of 40 patients who met the inclusion criteria from June 2014 to December 2014 were selected as the control group, who adopted routine nursing measures, 40 patients who met the inclusion criteria from January 2015 to June 2015 were assigned to the observation group. Bundles on prevention and treatment of oral mucositis caused by chemoradiotherapy for patients with nasopharyngeal carcinoma were edited using a series of evidence-based approach, and it was used to manage the patients of observation group. Results While doing 21, 28, 33 friction of radiotherapy, the oral mucositis level of 0 degree, Ⅰ degree,Ⅱ degree,Ⅲ degree and Ⅳ degree of the observation group were 8, 25, 7, 0, 0 cases;3, 11, 24, 2, 0 cases;0, 19, 13, 6, 2 cases respectively, which were lower than the control group whose degrees were 0, 31, 6, 3, 0 cases;0, 18, 11, 10, 1 cases;0, 9, 17, 9, 5 cases. The difference between the two groups was statistically significant （Z=-4.440,-3.441,-2.232, all P 〈 0.05 or 0.01）. While doing 21, 28, 33 friction of adiotherapy, the throat pain level of 0 degree, Ⅰ degree,Ⅱ degree,Ⅲ degree of observation group were 4, 31, 5, 0; 2, 22, 14, 2; 0, 26, 12, 2 cases respectively, which were lower than the control group whose degrees were 1, 22, 16, 1 cases; 0, 10, 23, 7 cases; 0, 10, 17, 13 cases. The difference between the two groups was statistically significant （Z=-3.137,-3.326,-3.518, all P〈0.01）. While doing 28, 33 friction of radiotherapy, the Self Rating Anxiety Scale of the observation group scored 56.76 ± 3.19, 58.72 ± 5.41, which were lower than 60.58 ± 2.46, 63.42 ± 4.97 in the control group. The difference between the two groups was statistically significant （t=11.746, 10.561, all P 〈0.01）. While doing 33 friction of radiotherapy, the self rating anxiety scale of the observation group was 60.56 ± 3.73, which was lower than 63.43 ± 4.77 in the control group. The difference between the two groups was statistically significant （t=-4.983, P〈0.01）. The following entries：swallow, sensation, eating in public, dry mouth, sticky saliva, feel sick of the quality of life questionnaire of the observation group were higher than the control group while doing 33 friction of radiotherapy. All the differences were statistically significant （t=-3.873-5.130, P〈0.05 or 0.01）. Conclusions The bundles could effectively prevent and treat oral mucositis caused by chemoradiotherapy for patients with nasopharyngeal carcinoma. It could release the throat pain, anxiety and depression of the patients, as well as improve the quality of life to some extent.