立体定向放射治疗肺癌患者不良反应观察及护理

Observation and nursing care of adverse reactions of stereotactic body radiation therapy in patients with lung cancer

目的观察肺癌患者立体定向放射治疗(stereotactic body radiation therapy,SBRT)不良反应及护理要点。方法对2014年9月~2016年6月本院收治的81例肺癌患者实施SBRT,治疗期间密切观察患者放疗不良反应,并给予相应的护理措施。结果随访时间4~25个月,患者治疗后1个月、3个月及6个月有效率分别为43.43%、72.73%、56.32%,1年总生存率为65.00%。主要不良反应为放射性肺炎,总发生率为20.99%(17例),大多集中在放疗后3~6个月。其中1~2级11例(13.58%),3~4级5例(6.17%),5级1例(1.24%)。出现放射性食管炎16例(19.75%);胸痛13例(16.05%);骨髓抑制2例(2.47%)。放疗后无患者出现严重心脏不良反应及肋骨骨折。经精心治疗及护理后,患者不良反应得到有效控制,均顺利完成放疗。结论 SBRT是治疗肺癌的有效方案,疗程中需密切观察患者并发症发生情况,及时给予针对性护理,防止并发症进展,应特别警惕放射性肺炎的发生。

Objective To observe the adverse effects and nursing points of stereotactic body radiation therapy（SBRT）in lung cancer patients. Methods A total of 81 patients with lung cancer who were admitted to our hospital from September 2014 to June 2016 were given SBRT. During the treatment period, the adverse reactions of radiotherapy were observed closely, and the corresponding nursing measures were given. Results The follow-up time was 4 to 25 months. The effective rate was 43.43%, 72.73% and 56.32% respectively at one month, three months and six months after the treatment. The one-year overall survival rate was 65.00%. The main adverse events were radioactive pneumonia,with a total incidence of 20.99%（17 cases）, mostly concentrated in the three to six months after radiotherapy. Among them, 11 cases（13.58%） were grade 1-2, five cases（6.17%） were grade 3-4, and one case（1.24%） was grade 5. 16 cases（19.75%） showed radiation esophagitis; chest pain was in 13 cases（16.05%）; bone marrow suppression was in two cases（2.47%）. No patients showed severe cardiac adverse reactions and rib fractures after radiotherapy. After careful treatment and care, the patients＇ adverse reactions were effectively controlled, and all patients were successfully completed radiotherapy. Conclusion SBRT is an effective regimen for the treatment of lung cancer. During the treatment, patients＇ complications should be closely observed, and targeted care should be given timely, so as to prevent the progress of complications. The occurrence of radiation pneumonia should be given particular attention.