化疗所致口腔炎的护理及其进展

口腔粘膜炎(oral mucositis，OM)是指口腔的炎症性和溃疡性的反映。是白血病患化疗后常见的并发症之一。世界卫生组织将OM分为0—IV级，此就化疗所致的口腔粘膜炎的机理、主要表现、护理进行综述。口腔粘膜炎主要表现为口腔溃疡和感染，加强口腔粘膜炎的预防和护理可以有效地防止局部和全身感染的发生。     

预防和治疗与肿瘤治疗相关的口腔粘膜炎的护理计划

据统计,在进行化疗、放疗及脊髓干细胞移植治疗的肿瘤患中,口腔粘膜炎的发生率高达40%～100%.口腔粘膜炎不仅影响口腔,还影响整个消化系统,它带来的临床症状包括疼痛、营养不良、局部和全身感染等。它还影响治疗方案的有效实施，增加住院时间和住院费用，还严重影响患的机体功能和生命质量（QOL），并导致终止化疗方案。治疗延迟、药物剂量减少和不连续的治疗会大大地影响整个治疗的有效实施，进而不能得到预期的疗效。     

粒细胞-巨噬细胞集落刺激因子治疗口腔粘膜炎的效果评价

口腔粘膜炎是化疗后常见的不良反应，是严重降低患生活质量的并发症之一。目前治疗口腔粘膜炎的方法很多，但大多因治疗过程需时较长而影响患对化疗反应的耐受性。本科采用局部应用粒细胞-巨噬细胞集落刺激因子(GM-CSF)治疗化疗所致的口腔粘膜炎取得了显的效果。现报告如下。     

急性放射性口腔粘膜炎的预防及护理

放射治疗口腔、鼻咽等部位肿瘤时不可避免地要发生或轻或重的急性放射性口腔粘膜炎，这种反应给病人造成很大的痛苦，甚至使治疗失败。通过对放射治疗中急性口腔粘膜炎发生原因的分析，对急性口腔粘膜炎进行预防护理及治疗，可达到有效控制急性放射性口腔粘膜炎、减轻病人痛苦、提高疗效的目的。     

肿瘤患者放疗或化疗并发口腔粘膜炎的防治进展

口腔粘膜炎是大部分肿瘤患在接受放化疗过程中极易出现的一种并发症，它常常给患造成很大的身心痛苦，护理人员应该采取有效措施预防、减轻及消除它的严重性和后遗症，提高患的生活质量，最有效最普通的方法是用温和的漱口液如盐水、小苏打等做口腔冲洗,近年来研究证明，一些其他制剂对口腔粘膜炎的防治有重要作用。     

非亲缘异基因骨髓移植相关性口腔粘膜炎的护理

目的 总结非亲缘异基因骨髓移植相关性口腔粘膜炎的临床观察及护理，以提高护士对相关病情的观察及护理水平。方法 对44例接受非亲缘异基因骨髓移植的患者在移植期间出现的口腔粘膜炎的观察、护理和治疗中的问题进行分析和总结。结果 44例有78％的患者发生不同程度的口腔粘膜炎，经过综合护理，除了移植失败的患者，余均在10-16天内好转。结论 针对不同的患者进行综合护理，是对非亲缘异基因骨髓移植相关性口腔粘膜炎护理的关键。     

预防和治疗与肿瘤治疗相关的口腔粘膜炎的护理计划

据统计,在进行化疗、放疗及脊髓干细胞移植治疗的肿瘤患者中,口腔粘膜炎的发生率高达40%~100%。口腔粘膜炎不仅影响口腔,还影响整个消化系统,它带来的临床症状包括疼痛、营养不良、局部和全身感染等。它还影响治疗方案的有效实施,增加住院时间和住院费用,还严重影响患者的机体功能和生命质量(QOL),并导致终止化疗方案。治疗延迟、药物剂量减少和不连续的治疗会大大地影响整个治疗的有效实施,进而不能得到预期的疗效。口腔护理计划是口腔粘膜炎处置方案的重要组成部分。系统研究资料显示,自我口腔护理计划能明显减少口腔粘膜炎的发生、发展…     

大剂量甲氨喋呤冲击治疗口腔粘膜炎的预防及护理

目的：对200例大剂量甲氨喋呤（MTX）冲击治疗导致口腔粘膜炎的病人进行观察及护理，为临床护理提供科学的依据。方法：计划并制定好口腔粘膜的观察内容，然后按填写的内容计划进行跟踪、分析和评估。结果：口腔粘膜炎发生2例。结论：口腔粘膜炎是大剂量MTX冲击疗法的严重并发症，但只要认真细致的做好口腔粘膜的观察及护理，其发生率则可下降。     

急性放射性口腔粘膜炎的预防及护理

放射治疗口腔、鼻咽等部位肿瘤时不可避免地要发生或轻或重的急性放射性口腔粘膜炎,这种反应给病人造成很大的痛苦,甚至使治疗失败。通过对放射治疗中急性口腔粘膜炎发生原因的分析,对急性口腔粘膜炎进行预防护理及治疗,可达到有效控制急性放射性口腔粘膜炎、减轻病人痛苦、提高疗效的目的。     

坏死性淋巴结炎患者的辨证施护

报道了12例坏死性淋巴结炎患的辨证施护，包括情志调摄，发热的护理及口腔粘膜、皮疹、关节疼痛的护理，介绍了出院指导。12例患治疗护理均有满意效果。     

Alimentary tract mucositis in cancer patients: impact of terminology and assessment on research and clinical practice

Background and significance The field of terminology and assessment of oral and gastrointestinal mucosal injury caused by high-dose cancer therapies in cancer patients has undergone important evolution in recent years. The advances are important for several clinical and research reasons. These reasons include improved patient management and design and conduct of clinical trials based on molecularly targeted therapies. For several decades leading up to the 1980s, terminology was characterized by varying use of “mucositis” and “stomatitis” to describe oral mucosal inflammatory changes and ulceration caused by cancer treatments. In addition, oral mucositis was viewed principally as an epithelial event and one that likely did not intersect with causative mechanisms associated with gastrointestinal mucositis. The term “stomatitis” was directed to oral toxicities and seemed to isolate these conditions from parallel events occurring throughout the alimentary tract and potentially other tissues as well. These perspectives and varying use of these terms resulted in several dilemmas, including (1) difficulty in accurately reporting incidence and severity of oral mucositis and, (2) an underappreciation of potential significance of alimentary tract mucosal toxicity relative to overall course of therapy, patient quality of life, and in some cases, survivorship. These and related components of the model relative to mucositis have undergone strategic shifts over the past 15 years. A 1989 National Institutes of Health Consensus Development Conference targeted oral mucositis research as one of the key areas for investigation relative to causation, clinical impact, and potential links with other complications in cancer patients. Research in this area over the past 15 years has evolved such that oral and gastrointestinal mucositis are now appropriately framed as a continuum of pathobiologic changes over time, with clinical impact that may well contribute to overall symptom clustering in selected patient cohorts.Objectives This paper will review history, current status, and new research directions associated with terminology and assessment of mucosal injury in cancer patients in the context described above.     

老年鼻咽癌患者放疗性口腔黏膜炎的评估工具及护理进展

口腔黏膜炎是老年鼻咽癌放疗患者最为常见的不良反应,它的发生往往严重影响老年患者的治疗及生活质量。本文综述了近年来关于老年鼻咽癌患者放疗性口腔黏膜炎的相关论文,从老年鼻咽癌患者放疗性口腔黏膜炎评估以及护理的角度进行综述。本综述将为护理人员在老年鼻咽癌患者放疗性口腔黏膜炎的临床护理工作中如何选择评估工具及制定护理干预措施提供参考。     

Assessing and managing chemotherapy-induced mucositis pain

Acute pain is the major clinical problem associated with mucositis. Mucosal tissue injury is a dose-limiting toxicity of many cancer therapies. Because the number of patients treated with combinations of high-dose chemotherapy agents is likely to increase, more patients are at risk for mucositis. Currently, no consensus exists regarding mucositis prevention, assessment, or treatment. Similarly, research is needed in methods to accurately assess and manage pain for mucositis. Multiple interventional approaches are needed to decrease the emotional and physical distress caused by acute oral pain and mucositis. An assessment tool that includes physical, functional, and pain parameters is presented. Although approaches to prevent and treat mucositis are increasing, appropriate assessment and timely directed interventions can minimize patient distress.     

Sucralfate mouthwash for prevention and treatment of 5-fluorouracil-induced mucositis: a randomized, placebo-controlled trial

A randomized, double-blind, placebo-controlled trial was conducted to evaluate the effectiveness of a sucralfate mouthwash in preventing and alleviating oral mucositis induced by 5-fluorouracil (5FU). A total of 81 patients with colorectal cancer were enrolled. Patients were studied during their first cycle of chemotherapy with 5FU and leucovorin (LV) daily for 5 days every 4 weeks (Mayo Clinic schedule). Patients were randomly allocated to receive either a sucralfate suspension or a placebo suspension that was identical in appearance. Patients were instructed to use the suspension as a mouthwash four times daily from the beginning of the chemotherapy cycle. All patients received oral cryotherapy. Patients graded the severity of their own symptoms on a daily basis, and this was the primary outcome measure. There was no difference in the frequency or severity of oral mucositis between the sucralfate- and the placebo-treated group. Some mucositis was reported by 79% of the patient group. Assessment of mucositis by trial staff underestimated the incidence of this problem. Results of this trial do not support the hypothesis that a sucralfate mouthwash can prevent or alleviate oral mucositis induced by 5FU. Patient reporting of mucositis is a more sensitive instrument for assessment of mucositis than review by medical staff.     

Reduction of oral mucositis by filgrastim (r-metHuG-CSF) in patients receiving chemotherapy

Mucositis, the inflammation and necrosis of mucosal membranes, is a serious and debilitating consequence of many cancer therapies. We were interested in the potential role of filgrastim (recombinant methionyl human granulocyte colony-stimulating factor, r-metHuG-CSF) in the reduction of mucositis. Patients with newly diagnosed small-cell lung cancer (SCLC) were treated with CAE chemotherapy (cyclophosphamide, doxorubicin, and etoposide) and placebo or filgrastim. If patients had an episode of febrile neutropenia, they received unblinded filgrastim in subsequent CAE cycles. Oral mucositis was considered to have occurred if a patient reported any clinical sign or symptom of oral mucositis with or without oral candidiasis. Oral mucositis was analyzed using the unadjusted chi-square test, and time to first episode of mucositis was analyzed using the stratified log-rank test as well as the Cox proportional hazards regression model. During cycle 1, placebo-treated patients had more episodes of mucositis (47%) compared with those patients randomized to filgrastim (28%). Across all cycles of treatment, 70% of placebo-treated patients experienced mucositis, compared with 53% of patients randomized to filgrastim. A significant reduction in the incidence of chemotherapy-related oral mucositis occurred across multiple cycles of treatment in patients treated with filgrastim.     

Methylene Blue for the Treatment of Intractable Pain Associated with Oral Mucositis

Oral mucositis is a common and often debilitating complication among cancer patients receiving radiation therapy to the head and neck or chemotherapy agents, or undergoing hematopoietic stem cell transplantation. Pain and decreased oral function associated with oral mucositis may persist long after the conclusion of therapy. Although most patients respond to conservative management, a subset of patients develops intractable pain with severe consequences. For some, the use of total parenteral nutrition with insertion of percutaneous endoscopic gastrostomy feeding tubes is the only alternative. Current recommendations to treat mucositis and its related pain include basic oral care, bland oral rinses, topical anesthetics, and systemic analgesics. We believe that chemical neurolysis of the affected areas with methylene blue used as an oral rinse is a noninvasive, efficient, safe, and cost‐effective alternative that can provide prolonged analgesia in patients with intractable pain of oral mucositis. The benefits of this therapy are reflected in its improvement of patients’ quality of life by enabling oral feeding and controlling pain. We report a series of 5 consecutive patients with intractable oral mucositis‐related pain despite conventional treatment with systemic opiates. All 5 patients responded well to the use of 0.05% methylene blue as mouth rinse, demonstrating sustained analgesia over 3 weeks. The treatment was tolerated well, and overall patient satisfaction was very high. We also observed that methylene blue rinse significantly reduced the total opioid requirement, as demonstrated by reductions in the patients’ morphine equivalent daily dose scores after its use. Our case series suggests that 0.5% methylene blue oral rinse therapy is an effective and inexpensive modality that can be used safely to palliate intractable oral pain in patients with mucositis associated with cancer treatment. To our knowledge, this is the first report using this therapy to treat pain from oral mucositis.     

Implementation of a hospital oral care protocol and recording of oral mucositis in children receiving cancer treatment

Purpose

This retrospective/prospective study was carried out to implement a standardized hospital oral care protocol and record the incidence of oral mucositis for inpatients with childhood cancer.

Methods

The implementation process included stages of collaboration, consultation, education, and evaluation. The retrospective part of the study documented the existing hospital oral care protocol and audited medical records of all pediatric patients diagnosed with cancer over a 12-month period. The frequency of recorded oral mucositis and the rate of referral to the pediatric dentistry department were assessed. Following evaluation of the retrospective study, the literature was searched to create a new hospital oral care protocol. Referral to the dental department was standardized and frequent in-service presentations were given to staff. The oral mucositis scale was recorded daily for all inpatients, and compliance rates were assessed.

Results

Fifty-nine patients’ medical records were audited during the retrospective study. Oral mucositis prevalence was clearly documented at 34%, while an additional 20% lacked a definitive diagnosis. During the prospective study, 38 patients were followed and had a verified incidence of oral mucositis of 33%. The rate of compliance of implementing the oral mucositis scale improved from 41% during the first 4 months to 87% during last 3 months. Referral rates to the dental department increased from 53% during the retrospective study to 100% during the prospective study.

Conclusions

Mutual understanding and collaboration between the oncology and dental departments in hospitals is crucial for standardizing patient care and for improving oral care standards.     

Healing action of topical chamomile on 5-fluouracil induced oral mucositis in hamster

Background  

Oral mucositis is a common complication in the treatment of cancer. Its management and prevention are seen as high priority in cancer patient care. The aim of the present study was to investigate the effect of topical chamomile in the treatment of oral mucositis induced by 5-fluoracil (5-FU) in hamsters.     

头颈部肿瘤放疗中口腔黏膜反应的治疗

目的探讨2种漱口液治疗肿瘤患者在放射治疗过程中急性上口腔黏膜炎的疗效。方法将87例头颈部肿瘤患者按随机数字表法分为2组,自制漱口液组（n=43例）和口泰漱口液组（n=44例）。2组在放疗过程中分别采用自制漱口液和口泰漱口液含漱,每次10mL,4～5次.d-1,自放射治疗开始后1周内使用,连续使用7周。根据RTOG/EORTC急性放射性黏膜炎分级标准对2组患者的疗效及口腔黏膜损伤情况进行比较。结果自制漱口液组有效率高于口泰漱口液组、Ⅲ级急性放射性黏膜炎发生率低于口泰漱口液组（均P〈0.05）。结论头颈部肿瘤患者在放疗过程中口腔黏膜反应是不可避免的,自制漱口液配制简单、价格便宜、疗效确定,在头颈部肿瘤患者放射治疗过程中可作为预防和治疗用药。     

护理干预对头颈部肿瘤放射治疗所致口腔黏膜炎的影响

目的：探讨护理干预对头颈部肿瘤放射治疗所致口腔黏膜炎的影响。方法：99例头颈部肿瘤患者随机分为两组,干预组在对照组的基础上,加强对患者的口腔卫生知识教育,实行口腔护理及物理性预防措施,合理使用抗生素。比较其与对照组之间口腔黏膜炎发生率的差异。结果：干预组口腔黏膜炎发生率66．7％,对照组发生率85．7％,两组比较差异有显著性（P〈0.05）,且干预组发生口腔黏膜炎的程度较轻,差异亦有显著性（P〈0.05）。结论：积极的护理干预可降低头颈部肿瘤放射治疗所致口腔黏膜炎的发生率。