三种皮肤外用药在防治鼻咽癌患者放射性皮炎中的效果研究

Effect of three kinds of skin external use in the prevention and treatment of radiation dermatitis in patients with nasopharyngeal carcinoma

目的：探讨3种皮肤外用药在防治鼻咽癌患者放射性皮炎中的效果。方法将2014年8月至2015年10月收治的120例鼻咽癌患者，按照随机数字表法分为芦荟胶组、三乙醇胺乳膏组、放射治疗皮肤防护剂（利肤宁）组各40例。3组患者除外用药不同外，其他条件保持相对一致。比较3组患者在放疗期间发生放射性皮炎的分级、面积、局部疼痛评分、外用药物费用情况及首次发生放射性皮炎时的放疗剂量。结果3种皮肤外用药均有防治作用，但效果不同。3组患者100%发生放射性皮炎，但发生的级别不同。芦荟胶组和三乙醇胺乳膏组主要为Ⅱ级放射性皮炎，发生Ⅳ级放射性皮炎的病例分别为2、4例，利肤宁组主要为Ⅰ级和Ⅱ级放射性皮炎，Ⅲ级放射性皮炎仅2例，无Ⅳ级放射性皮炎的发生，3组比较差异有统计学意义（H=8.758，P＜0.05）。3组患者用药后均有疼痛发生，三乙醇胺乳膏组12例、利肤宁组7例、芦荟胶组仅2例（H=8.586，P＜0.05）。3组皮肤外用药费用不同，三乙醇胺乳膏组平均费用546.0元、利肤宁组458.2元、芦荟胶组157.5元。3组间两两比较，三乙醇胺乳膏组和芦荟胶组疼痛差异有统计学意义（χ2=9.62，P＜0.05），芦荟胶优于三乙醇胺乳膏，能更有效地缓解放射野局部疼痛，但在放射性皮炎分级、面积和首次发生放射性皮炎时放疗剂量方面差异无统计学意义（P＞0.05）；三乙醇胺乳膏组和利肤宁组仅疼痛差异无统计学意义（χ2=2.47，P＞0.05），其余各项观察指标均差异有统计学意义（P＜0.05），利肤宁优于三乙醇胺乳膏，能更好地减轻和延缓放射性皮炎的发生和恶化，避免放射性皮炎面积的扩大；芦荟胶组和利肤宁组仅在放射性皮炎分级方面差异有统计学意义（χ2=6.32，P＜0.05），利肤宁优于芦荟胶，利肤宁更有利于减轻和延缓放射性皮炎的发生，其余各项观察指标均差异无统计学意义（P＞0.05）。结论综合皮肤外用药防治鼻咽癌患者放射性皮炎的疗效、疼痛和价格3个方面情况，利肤宁作为三乙醇胺和芦荟的合剂不仅能有效减轻和延缓放射性皮炎的发生，减轻放射野局部疼痛感受，且价格适中，患者更易接受，值得临床推广使用。

Objective To investigate the effect of three kinds of skin external use in the prevention and treatment of radiation dermatitis in patients with nasopharyngeal carcinoma. Methods 120 patients with nasopharyngeal carcinoma who were treated form August 2014 to October 2015 were divided into three groups by random number table method, namely, aloe vera gel group, triethanolamine cream group, radiation treatment of skin protectants (lifuning) group. Except for different medications among the groups, the other conditions remained relatively consistent. 3 groups were compared in the radiotherapy classification, area, local pain score, and topical drug costs during the radiotherapy and the&nbsp;radiation dose when radiation dermatitis occurred the first time. Results Three kinds of skin external use had a preventive effect, but the effect was different. Three groups′ patients with radiation dermatitis incidence was 100%, but occurred at different levels. Aloe vera gel cream group and triethanolamine group were mainly for gradeⅡradiation dermatitis, grade IV radiation dermatitis occurred in 2 cases and 4 cases, lifuning group were mainly for grade Ⅰ and grade Ⅱ radiation dermatitis, grade Ⅲ radiation dermatitis only occurred 2 cases, noⅣgrade radiation dermatitis occurred. Comparison among the three groups, the difference was statistically significant (H=8.758,P<0.05). 3 groups of patients after treatment all suffered pain, 12 patients in triethanolamine cream group , 7 patients in lifuning group , only 2 cases in aloe vera gel group (H=8.586,P<0.05). The average cost of skin external used in 3 groups was different, triethanolamine cream group was 546.0 yuan, lifuning group was 458.2 yuan, and aloe vera gel group was 157.5 yuan. Among the three groups pairwise comparison, the differences in triethanolamine cream group and aloe vera gel group were statistically significant in pain (χ2=9.62,P<0.05), aloe vera gel group was better than the group of triethanolamine cream, the differences among radiation dermatitis grade, size and radiation dose of radiation dermatitis occurred the first time were not statistically significant (P>0.05). The difference between in lifuning group and triethanolamine cream group in pain had no statistically significant (χ2=2.47,P>0.05), other indexes had significant differences (P < 0.05). Lifuning was better than the triethanolamine cream to reduce and delay the onset and deterioration of radiation dermatitis and could prevent a widening of the area of radiation dermatitis;aloe vera gel group and lifuning group had a significant difference in radioepidermitis grade (χ2=6.32,P<0.05). Lifuning was better than the aloe vera gel and was more conducive to reduce and delay the occurrence of radiation dermatitis, other indexes differences had no statistically significant (P>0.05). Conclusions Considering the efficacy, pain and price three aspects which skin external use prevention and treatment radiation dermatitis patients with nasopharyngeal carcinoma, lifuning as the mixture of triethanolamine and aloe can effectively reduce and delay the chance of radiation dermatitis, reduce the radiation field experience of local pain, and affordable, the patients are more acceptable, it′s worthy of clinical use.