表阿霉素在泌尿系肿瘤术后应用的副反应危险因素分析

Analysis of risk factors of adverse reaction of epirubicin in the postoperative patients with urinary tract cancer

目的 调查表阿霉素在泌尿系肿瘤术后应用的副反应危险因素,提出相关护理对策与方法.方法 采用前瞻性研究方法,选取2013年2月到2016年1月选择在本院诊治的早期肾癌患者220例,根据随机数字表法分为观察组与对照组各110例,所有患者都给予肾癌根治术,术后给予表阿霉素辅助化疗,对照组在化疗过程中给予常规护理,观察组在对照组护理的基础上给予分级护理.结果 全部患者均顺利完成化疗,化疗期间共出现副反应40例,其中血液学毒性11例,肝脏毒性9例,胃肠反应16例,外周神经毒性4例,发生率为18.2%.观察组的化疗副反应发生率明显少于对照组,对比差异明显（P〈0.05）;化疗后观察组的SCL-90得分为（2.48±0.51）分,对照组为（3.11±0.51）分,观察组明显少于对照组（t=3.298,P〈0.05）.单因素分析显示年龄、糖尿病、吸烟、分级护理、预防性使用抗生素、卧床时间与副反应相关（P〈0.05）;进一步多因素分析显示年龄、糖尿病、分级护理、预防性使用抗生素、卧床时间是副反应的危险因素（P〈0.05）.结论 表阿霉素在泌尿系肿瘤术后应用的副反应比较常见,多与年龄、糖尿病、护理方法、预防性使用抗生素、卧床时间等有关,分级护理可以减少副反应的发生,有利于提高患者的预后生活质量.

Objectives To survey the risk factors of adverse reaction of epirubicin in the postoperative patients with urinary tract cancer, put forward the related nursing strategies and methods.Methods The prospective study method was applied, from February 2013 to January 2016, 220 patients of postoperative patients with urinary tract cancer in our hospital for diagnosis and treatment were selected.All the patients were randomly divided into observation group and control group, with 110 cases in each group.All patients were given radical nephrectomy and the postoperative given epirubicin chemotherapy, while the control group was given routine nursing care in the course of chemotherapy, the observation group were added grading nursing care on the basis of the control group.Results All patients were successfully completed chemotherapy, there were 40 patients of adverse reactions during chemotherapy that included 11 patients of hematologic toxicity, 9 patients of liver toxicity, gastrointestinal reactions in 16 patients, peripheral neurotoxicity in 4 patients, the incidence rate was 18.2%.But the adverse reaction rate in the observation group was significantly less than the control group （P〈0.05）.After chemotherapy, the SCL-90 score in the observation group was （2.48±0.51） scores, so that was （3.11±0.51） scores for the control group, the observation group was less than that of the control group （t=3.298, P〈0.05）.Univariate analysis showed that age, diabetes, smoking, grading nursing care, preventive use of antibiotics, time of lying in bed were related to the side reactions （P〈0.05）.Further multivariate analysis showed that age, diabetes, grading nursing care, preventive use of antibiotics, time of lying in bed were the risk factors of adverse reactions （P〈0.05）.Conclusions Epirubicin in urinary tumor postoperative application of side reactions is more common.The age, diabetes, grading nursing care, preventive use of antibiotics, time of lying in bed were the risk factors of adverse reactions, grading nursing can reduce the occurrence of side reactions and is conducive to improve the prognosis of the patients quality of life.