碳酸氢钠联合氟康唑对大剂量化疗致口腔黏膜炎保护作用的初步研究

目的 探讨大剂量化疗致口腔黏膜炎的预防方法及护理对策.方法 以80例接受大剂量化疗患者为观察对象,随机分为实验及对照2组, 实验组采用碳酸氢钠联合氟康唑药物自制成口腔含漱液,对照组予以朵贝氏液漱口,在化疗开始时同步应用,观察口腔黏膜炎的发生与严重程度、平均住院日以及生活质量.结果 实验组口腔黏膜炎发生率及住院天数明显低于对照组,且生活质量评分也高于对照组.结论 采取积极有效的预防与护理对策能够降低大剂量化疗所致的口腔黏膜炎的发生,提高患者生活质量,减轻患者痛苦.     

化疗致口腔黏膜炎的相关因素分析

摘要：目的 探讨化疗所致口腔黏膜炎的相关因素，为制订预防口腔黏膜炎的护理干预措施提供参考。方法 对５６７例接受氟尿嘧啶类为主抗癌药物治疗患者于化疗期口服别嘌呤醇片或含漱０．８％别嘌呤醇溶液预防口腔黏膜炎，每天观察并记录患者口腔情况、化疗不良反应及睡眠情况等。对观察指标进行统计分析。结果 患者发生口腔黏膜炎４９例（８．６％），影响口腔黏膜炎发生的主要相关因素为口腔ｐＨ值、唾液黏稠度、腹泻、睡眠（均Ｐ＜０．０１）。结论 需针对化疗所致口腔黏膜炎的主要相关因素进行护理干预，以降低黏膜炎的发生率及程度，减轻患者的痛苦。关键词：肿瘤；　化疗；　口腔黏膜炎；　相关因素分析中图分类号：Ｒ４７２；Ｒ７８１．５　　文献标识码：Ａ　　文章编号：１００１-４１５２（２００７）１７-０００７-０３     

化疗药物致消化道黏膜炎的治疗及护理进展

化疗是治疗恶性肿瘤主要的方法之一,但化疗后所导致的消化道黏膜炎的发生率为40％,尤其是应用甲氨蝶呤(methotraxate,MTX)、5-氟尿嘧啶(5-fluorine urea pyrimidine,5-FU)、阿糖胞苷、长春新碱、依托泊苷等化疗药时,黏膜炎的发生率为90％[1].化疗性黏膜炎的发生不仅导致患者的治疗成本上升和住院时间延长,同时增加患者的身心痛苦,降低患者生活质量[2-3].为更有效地预防和处理化疗致消化道黏膜损伤,现将国内外有关化疗致消化道黏膜损伤治疗及护理进行综述.     

多柔比星脂质体联合化疗致口腔黏膜炎的观察与护理

目的探讨多柔比星脂质体(里葆多)联合化疗致口腔黏膜炎的护理方法。方法对我科2015年9月-2016年12月住院的31例里葆多联合化疗患者通过电话随访或当面检查等方式,观察其口腔黏膜炎的发生情况,并加强基础预防及护理。结果本组患者口腔黏膜炎的总发生率为67.7%。随化疗次数的增加,口腔黏膜炎发生的程度越严重;第1周期发生率为29%,第2周期为41.9%,第3周期为67.7%,第3周期后发生情况趋于稳定。结论口腔黏膜炎是里葆多联合化疗较常见的并发症,应加强预防及护理。     

医护一体化护理模式对鼻咽癌放疗致口腔黏膜反应患者生活质量的影响

目的:探讨医护一体化护理模式对鼻咽癌放疗致口腔黏膜反应患者生活质量的影响。方法:将120例行放疗治疗的鼻咽癌患者根据抽签法分为观察组和对照组各60例,观察组化疗期间应用以医护一体化为中心的护理模式,对照组化疗期间应用常规性护理;比较分析两组放射性口腔黏膜炎发生程度及放射性疼痛程度,干预前后应用中国头颈癌患者生命质量测定量表(QLICP-HN)测定两组生活质量。结果:观察组放射性口腔黏膜炎、放射性口腔疼痛发生程度较对照组轻(P0.01);干预后观察组心理功能、躯体功能、生活功能、共性症及副作用和总生存质量评分高于对照组(P0.01)。结论:医护一体化护理模式可降低鼻咽癌放疗患者口腔黏膜炎及口腔疼痛感,改善患者生活质量。     

放化疗致放射性皮炎以及口腔黏膜炎的临床护理对策

目的 探讨针对性护理干预对策在防治放化疗致放射性皮炎、口腔黏膜炎中的应用效果.方法 选择于该院接受放化疗并发生放射性皮炎或口腔黏膜炎的鼻咽癌患者80例为研究对象.根据患者治疗期间护理方式差异分为观察组与对照组,观察组40例接受放化疗并发症针对性护理干预措施,对照组40例仅接受常规临床护理干预,比较两组干预后放射性皮炎、口腔黏膜炎发生程度以及生活质量、护理满意度、治疗依从性.结果 观察组干预后放射性皮炎、口腔黏膜炎发生程度明显低于对照组(P<0.05);观察组干预后生活质量、护理满意度、治疗依从性评分明显高于对照组(P<0.05).结论 对放化疗所致的放射性皮炎、口腔黏膜炎患者实施针对性护理干预可有效改善放射性皮炎、口腔黏膜炎发生程度,并可显著提高患者生活质量、护理满意度以及治疗依从性,具有应用及推广价值.     

造血干细胞移植患者的口腔护理体会

目的探讨造血干细胞移植患者发生口腔黏膜炎的临床特点与转归，实行有效的护理干预，降低并控制口腔黏膜炎的发生率和程度，保证治疗的顺利进行。方法回顾性分析我科171例造血干细胞移植患者发生口腔黏膜炎的发生率、口腔黏膜炎分级及临床特征，观察口腔黏膜炎对患者生活质量的影响，并对其进行基础护理、专科护理、心理护理。特别是认真及时做好患者的口腔护理。口腔护理液选用2．5％的碳酸氢钠和1：2000的洗必泰溶液交替使用，必要时加用制霉菌素片。操作时动作应轻柔，以防止进一步损伤黏膜，口腔护理液要擦到口腔中的所有部位，重点部位要多擦几遍，并指导患者漱口。结果本组171例干细胞移植患者出现口腔黏膜炎117例，发生率为68．42％，经积极有效地治疗及口腔护理，本组117例患者口腔黏膜炎均痊愈。结论口腔黏膜炎是造血干细胞移植患者常见而严重的并发症，通过仔细观察、有效进行口腔护理，可以降低其发生率及严重程度，保证治疗的顺利进行。     

护理干预对预防鼻咽癌放疗患者口腔黏膜炎的效果

目的探讨护理干预对预防鼻咽癌放疗患者口腔黏膜炎的效果。方法选取2014-06—2015-07因患鼻咽癌于空军青岛航空医学鉴定训练中心进行化疗治疗的患者100例,按照随机分配的原则,50例接受常规护理的患者为对照组,另50例接受护理干预的患者为观察组,比较两组患者在预防口腔黏膜炎方面的临床效果。结果观察组患者在前4周的放射治疗下口腔黏膜炎的发生率明显低于对照组患者,差异具有统计学意义(P0.05);两组患者在接受放射治疗5~7周内口腔黏膜炎的发生率差异无统计学意义(P0.05);观察组患者第7周末口腔黏膜炎Ⅰ级和Ⅱ级发生率明显高于对照组患者,差异具有统计学意义(P0.05),口腔黏膜炎Ⅲ级和Ⅳ级的发生率明显低于对照组,差异具有统计学意义(P0.05)。结论采用护理干预可有效降低患者口腔黏膜炎的发生,对于发生口腔黏膜损害的患者可有效控制破坏的范围,明显降低患者的痛苦。     

放化疗致口腔黏膜炎病人生活质量及其影响因素研究

目的 了解放化疗性口腔黏膜炎患者的生活质量水平及其影响因素。方法 采用描述性研究方法对南通市3家综合性医院220例放化疗致口腔黏膜炎的患者进行问卷调查。自行设计一般问卷和口腔黏膜炎患者生活质量特异性量表,应用统计描述、方差分析、t检验、多元逐步回归方法分析放化疗性口腔黏膜炎患者的生活质量及其影响因素。结果 调查220例,回收有效问卷205例。205例放化疗性口腔黏膜炎的患者的生活质量总得分（100.30±22.16）分;单因素分析显示年龄、文化程度、家庭月收入、治疗方法是患者生活质量的影响因素(P<0.05)。结论 放化疗性口腔黏膜炎患者的生活质量较低,影响口腔黏膜炎患者生活质量的因素较多。     

中西医结合口腔护理预防化疗患者口腔黏膜炎的效果观察

目的 探讨中西医结合口腔护理预防化疗后口腔黏膜炎的效果.方法 将90例化疗患者按人院单双日分成中西医结合组50例和对照组40例.对照组行常规口腔护理,3次/d,共5 d;中西医结合组在对照组的基础上用自制的"清热解毒漱口液"漱口,3次/d,共5 d.比较化疗后第5天两组患者口腔黏膜炎的发生情况.结果 两组患者口腔护理后第5天口腔黏膜炎发生情况比较,差异均有统计学意义(P<0.01),中西医结合组口腔黏膜炎的发生率明显低于对照组.结论 中西医结合口腔护理可有效地降低化疗后口腔黏膜炎的发生率,其方法简便易行,值得临床推广应用.     

肝癌患者肝移植术后行FOLFOX化疗的护理

目的探讨肝癌患者肝移植术后行奥沙利铂＋卡培他滨＋左亚叶酸钙（FOLFOX）化疗的护理体会。方法2008年7月～2011年7月,本院对63例肝移植术后患者应用FOLFOX方案进行化疗,总结患者化疗期间的护理要点。结果63例患者共完成268个周期的化疗,出现末梢神经异常48例,恶心和呕吐41例,腹泻32例,骨髓抑制36例,口腔黏膜炎（溃疡）11例,静脉炎1例。结论肝癌患者肝移植术后行FOLFOX化疗会出现比较严重的不良反应,针对FOLFOX的特点实施针对性的护理措施,可以降低化疗药物的毒副反应,减轻患者化疗的痛苦,从而提高患者的生存质量。     

造血干细胞移植患者口腔粘膜炎的观察及护理

目的观察41例患者口腔粘膜炎发生、发展的规律,为临床护理提供科学的依据。方法预先设计好口腔粘膜炎的观察表,每次口腔护理前对口腔粘膜认真评估,逐项填写。结果本组口腔粘膜炎的发生率为83.7%%;发生部位颊(46.3%),舌(34.1%)、唇(31.7%)、齿龈和腭(均为29.3%);发生程度0级、Ⅰ级占83.7%;发生与粒细胞下降速度、幅度、持续时间均有关;粘膜炎时微生物检测均为常居菌。结论口腔粘膜炎是造血干细胞移植患者常见而严重的并发症。虽发生率高,但只要仔细观察、有效护理,是可以降低口腔粘膜炎发生程度的。     

奈达铂联合5-Fu治疗头颈部肿瘤5例护理体会

目的通过对5例头颈部肿瘤化疗患者的护理,提高患者的生存质量。方法针对患者肿瘤的特殊性和共同特点,予相应的心理护理、用药过程护理、化疗药物毒副作用的护理、饮食护理、口腔护理和健康教育。结果1例鼻咽癌患者化疗后出现Ⅱ度骨髓抑制,予重组集落细胞刺激因子150μg皮下注射,24h后复查血常规,白细胞上升;5例患者情绪稳定,善于沟通,达到良好的治疗效果。结论奈达铂治疗指数高,毒副作用相比顺铂小,减轻了患者精神压力和对化疗的恐惧感,同时加强了口腔局部并发症的护理,改变了不良卫生习惯,消除口腔异味,增加了患者的自信心,提高了患者的生存质量。     

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.     

Current trends in managing oral mucositis

Oral mucositis is an inflammatory and ulcerative process of the oral cavity that results from an assault on the epithelial mucous membrane tissue and most commonly is associated with the administration of radiotherapy and chemotherapy. The incidence of oral mucositis ranges from 15%-40% in patients receiving stomatotoxic chemotherapy or radiotherapy and 70%-90% in bone marrow recipients. Knowledge regarding the pathophysiology of oral mucositis has evolved and now guides practice. Assessment tools to measure the level of mucositis provide valuable data concerning the status of the oral cavity. No single oral assessment tool has been found to be appropriate in all clinical settings. Mucositis has a significant impact on patients' quality of life and treatment plan. Management of oral mucositis is aimed at minimizing this side effect and its subsequent sequelae. The strategies of care are geared toward early intervention and supportive care for patients at risk for developing mucositis and include specific targeted therapies for the management of debilitating side effects. This article provides an overview of the risk factors, pathophysiology, incidence, impact, clinical presentation, oral assessment tools, management strategies, and nursing implications related to oral mucositis.     

Development and Validation of the Oral Mucositis Risk Assessment Scale in Hematology Patients

Objectives: This study was conducted as a methodological study to develop a valid and reliable scale to evaluate the risk of developing oral mucositis in hematology patients.Data Sources: The universe and sample were comprised of one hundred eighty-seven in-patients who were taken to receive chemotherapy in the hematology clinics over a six-month period. The data were collected through the Patient Diagnosis Form, the World Health Organization's Mucositis Evaluation Form and Oral Mucositis Risk Assessment Scale in Hematology Patients developed. Risk of “taking high-dose chemotherapy regimen”, “neutropenia”, “dry mouth”, “pain”, “leukopenia”, “parenteral feeding”, “previous history of oral mucositis” and “chemotherapy or radiotherapy in the past” were found as an oral mucositis risk factor. We have added “using high-risk chemotherapeutic agents”, “bone marrow transplant”, “ head-neck or mouth cancer” which we consider clinically important. The scale consists of 11 items. The sensitivity value is 0.941 and the selectivity value is 0.724.Conclusion: We recommend that use the Oral Mucositis Risk Assessment Scale in Hematology Patients. Similar studies should be performed in oncology clinics and especially in patients receiving head and neck, oral radiotherapy. Implications for nursing practice: Oral mucositis is an important problem for hematology patients. nurses' risk assessment and early intervention to oral mucositis prevent the formation and complications of oral mucositis.     

A guide to managing the pain of treatment-related oral mucositis

Oral mucositis is a common complication of chemotherapy and/or radiotherapy and can be a significant problem for patients undergoing cancer treatment or bone marrow transplantation. Frequently, there is a major adverse impact on quality of life, particularly with pain and interference with oral function. In patients who are immunocompromised or debilitated, this complication can become life threatening. Currently, there is no single intervention that completely prevents or treats oral mucositis. The object of this article is to provide an overview for the nurse of the evidence for several options that may be of value in managing the pain which is often associated with this condition.     

白血病化疗后口腔病变的多因素护理干预

目的 探讨多因素护理干预对预防和控制白血病化疗后口腔病变的效果。方法 对78例住院化疗的白血病患者进行包括以健康宣教、口腔pH值矫正、口腔冷却疗法及口腔溃疡分度护理相结合的多因素护理干预,评估其口腔病变的发生率及严重程度,并与未干预组进行对比。结果 实验组口腔病变的发病率及严重程度均明显低于对照组。差异具有显著性。结论 采取以健康宣教、口腔pH值矫正、口腔冷却疗法及口腔溃疡分度护理相结合的多因素护理干预,可有效地预防和控制白血病患者因化疗所致的口腔炎的发生。     

基于PDCA的护理管理在干细胞移植患者并发口腔黏膜炎中的应用效果

目的探讨基于PDCA的护理管理在造血干细胞移植患者并发口腔黏膜炎中的应用效果。方法采用便利抽样法,选取2016年1月—2017年1月在郑州大学第一附属医院行造血干细胞移植的患者120例,采取随机数字表法分为对照组和观察组,每组60例。对照组采用传统的护理管理模式,观察组在对照组的基础上,采用基于PDCA的护理管理模式。比较两组患者口腔黏膜炎发生情况、口腔黏膜炎完全愈合的时间、因口腔黏膜炎所产生的疼痛消失时间、对护理服务满意情况。结果干预后观察组患者Ⅰ~Ⅳ级黏膜炎发生率较对照组降低,差异有统计学意义(P<0.05);观察组患者Ⅰ~Ⅳ级黏膜炎的完全愈合时间均短于对照组,差异有统计学意义(P<0.05);观察组患者Ⅰ~Ⅳ级黏膜炎的疼痛完全消失时间短于对照组,差异有统计学意义(P<0.05);观察组对护理服务的满意率为76.67%(46/60),高于对照组的53.33%(32/60),差异有统计学意义(P<0.05)。结论基于PDCA的护理管理模式能够降低造血干细胞移植患者口腔黏膜炎发生率,促进口腔黏膜炎愈合,缓解患者疼痛,提高护理满意度。