雾化吸入加吸氧防治放射性口腔反应效果观察

放射性口腔反应是头颈部肿瘤放射治疗中常见急性放射反应，临床表现为口干、咽痛等，严重者可致滴水难咽而中断放疗，影响放疗效果。我科１９９５年８月至１９９７年３月，采用雾化吸入加吸氧防治放射性口腔反应病人２５例，效果较好，现总结如下。１资料与方法１１一般...     

抗氧化食物联合中药防治放射性口咽黏膜炎

目的探讨抗氧化食物联合中药对鼻咽癌放射性口腔黏膜损伤的预防及治疗效果。方法选择2012年6月至2014年3月我科鼻咽癌放疗患者62例,随机分为对照组、中药组与综合组。对照组(20例)予常规口腔护理;在此基础上,中药组(25例)给予全疗程益气养阴解毒合剂含漱后吞服,综合组(17例)给予全疗程益气养阴解毒合剂与抗氧化食物治疗。疗程结束观察急性放射性口咽黏膜损伤程度、口腔疼痛情况、口腔pH值异常发生率和真菌感染率。结果疗程结束后,三组急性放射性口咽黏膜损伤分级比较,差异无统计学意义(P0.05),综合组口腔黏膜损伤程度较轻;三组不同时间VAS评分比较,干预主效应、时间效应和交互效应均P0.05,综合组VAS评分最低;三组口腔pH值异常发生率比较,差异有统计学意义(P0.05),但两两比较,差异无统计学意义(均P0.0125);三组真菌感染率比较,差异无统计学意义(P0.05)。结论抗氧化食物联合中药能有效防治鼻咽癌急性放射性口咽黏膜损伤,维持口腔正常pH值,改善口腔真菌感染状况,对口腔疼痛有较好的抑制作用。     

一次性双圈氧气雾化吸入器在气管插管患者气道湿化中的应用

重症颅脑损伤患者因意识障碍,再加上呼吸功能受损,使用脱水剂,呼吸道分泌物多且黏稠以及舌后坠等原因导致呼吸道不畅,常需气管插管,但黏稠痰液甚至痰痂常阻塞患者呼吸,甚至发生窒息.因此,加强气管插管的护理非常重要.充分而恰当的气道湿化可以有效减少人工气道并发症.2011年1～5月,我们采用一次性双圈氧气雾化吸入器对30例气管插管患者行持续氧气雾化吸入湿化气道,效果满意,介绍如下.     

参麦注射液雾化吸入防治放射性口腔炎效果观察

目的评价参麦注射液雾化吸入防治放射性口腔炎的临床效果。方法将60例鼻咽癌患者随机均分为观察组和对照组,皆给予常规口腔护理。观察组每次漱口后用参麦注射液20ml加蒸馏水50ml雾化吸入,3a／d,每次30min,至放疗结束;对照组每次漱口后用调成糊状的思密达均匀涂于口腔黏膜,3a／d,至放疗结束。结果观察组口腔黏膜反应出现时间为（30．25±1．54）d,对照组为（22．32±1．68）d,两组比较,差异有统计学意义（P〈0．01）;观察组口腔黏膜反应程度显著轻于对照组（P〈0．01）。结论参麦注射液雾化吸入在预防和减轻放射性口腔黏膜炎方面具有较好的疗效。     

循证护理在鼻咽癌放疗口腔黏膜反应中的应用

目的:应用循证护理探讨鼻咽癌患者放疗期间放射性口腔黏膜损伤护理干预的有效干预方法。方法:根据30例患者产生口腔黏膜反应的具体情况,提出护理问题,收集相关证据,结合实际制订切实可行的护理计划,采取相应的护理措施。结果:30例患者干预后口腔黏膜反应均得以缓解,减轻了患者的痛苦,患者能顺利完成放射治疗,达到有效的照射剂量。结论:应用循证护理找出鼻咽癌放疗患者口腔黏膜损伤因素,采用循证护理寻求科学完整的护理方案,有助于提高护理质量。     

“清补并用”防治放射性口腔黏膜炎的思路与进展

放疗是头颈部恶性肿瘤的主要治疗手段,放射性口腔黏膜炎是放射线造成的一种口腔黏膜毒性反应,大多数头颈部肿瘤患者在接受放疗的过程中都会经历不同程度的放射性口腔黏膜炎。联合化疗、靶向治疗或免疫治疗的放疗使得该毒性变得更普遍且程度更重,这严重影响了患者的生活质量以及对抗肿瘤治疗的耐受性。中医药已在肿瘤防治的临床实践中广泛应用,能起到增效减毒的作用,因此,研究中医药防治该病的有效方法对于提高患者的抗肿瘤治疗依从性、缩短住院时间、减少抗生素和止痛药的使用以及提高患者生活质量意义重大。     

医护人员防治癌症放化疗患者口腔黏膜炎知信行调查

目的描述肿瘤科医护人员对口腔黏膜炎防治的认知、态度、行为情况,分析口腔黏膜炎防治的影响因素。方法自行设计医护人员对癌症放化疗患者口腔黏膜炎防治的认知、态度、行为调查问卷,对225名肿瘤科医护人员进行调查。结果医护人员的认知、态度、行为得分分别为（6．63±1．75）分、（29．17±3．99）分、（23．16±6．42）分;医护人员的态度情况和行为情况之间呈显著正相关（P〈0．01）;医护人员进行1：7腔黏膜炎防治的影响因素包括责任心、知识掌握程度、工作量、措施的有效性、患者的依从性、经济因素等。结论医护人员的认知水平较低,态度较积极,行为水平一般,防治癌症患者口腔黏膜炎的影响因素包括患者方面和医护人员方面。应加强医护人员相关知识的培训,提高其认知水平;加强患者的健康教育,提高其对防治措施实施的依从性。     

开胸术后患者氧气射流雾化吸入方法的改进

目的探讨改进开胸术后患者氧气射流雾化吸入的方法,以增进排痰的有效性。方法将176例开胸术后患者按住院时间分为观察组和对照组各63例。对照组按常规方法行雾化吸入,观察组改进雾化吸入方法，即于吸气的第1秒患者以中、示指并拢堵住雾化气出气口,第2～3秒中、示指松开1条缝隙，待吸气毕手指并拢仍堵住出气口并移吸嘴于口外，缩唇呼气后似前吸气。均每次15～25min。结果观察组雾化吸入462例次，对照组448例次。观察组呼吸频率、吸入障碍程度、有效咳痰率、SpO2≥0．98例次及肺部感染率均显著优于对照组（P〈0．01．P〈0．05）。结论改进后的雾化吸入方法可显著提高排痰效果，有利于降低肺部感染率。     

重组人表皮生长因子联合复方漱口液治疗放射性口腔黏膜炎

目的 探讨重组人表皮生长因子(rhEGF)联合复方漱口液治疗放射性口腔黏膜炎的效果.方法 将86例头颈部肿瘤接受放疗并发放射性口腔黏膜炎患者随机分为观察组(44例)和对照组(42例),对照组采用复方漱口液含漱,观察组采用复方漱口液含漱后5 min将rhEGF均匀喷涂于黏膜创面,治疗1周后比较疗效.结果 观察组治疗效果显...     

一次性塑料杯在氧气雾化吸入中的应用

氧气雾化吸入是利用高速氧气气流使药液形成雾状，由呼吸道吸入而达到抗感染、止咳、祛痰、平喘的作用。因氧气在经过液体时会使液体的温度降低，从而使药罐的温度比室温低，造成空气中的水蒸气在药罐外凝成水滴，滴落打湿衣被，给患者带来不适。     

放射性口腔黏膜炎患者医护一体化疼痛护理干预

目的探讨基于医护一体化的疼痛护理干预对放射性口腔黏膜炎患者生存质量及营养状态的影响。方法将100例鼻咽癌放疗患者分为观察组和对照组各50例,对照组实施常规护理,观察组给予医护一体化管理模式下的疼痛护理干预。比较两组患者放射性口腔黏膜炎及放射性口腔疼痛发生程度、营养状况及生存质量评分。结果观察组患者放射性口腔黏膜炎、放射性口腔疼痛发生程度显著轻于对照组(均P0.01),营养风险评分显著低于对照组,生存质量评分显著优于对照组(均P0.01)。结论医护一体化疼痛管理模式可降低鼻咽癌放疗患者放射性口腔黏膜炎及放射性口腔疼痛的发生程度,改善营养状况及生活质量。     

食物辅助锻炼对鼻咽癌放化疗患者康复的作用

目的探讨食物辅助锻炼对促进鼻咽癌放化疗患者康复的可行性及有效性。方法将100例鼻咽癌放化疗患者按病房分为对照组和观察组各50例。对照组采用常规的9步鼻咽操锻练,观察组在此基础上增加食物辅助锻炼。结果放化疗治疗期间观察组口腔黏膜炎显著轻于对照组,放化疗后1年观察组张口困难程度显著低于对照组（均P〈0.01）。结论鼻咽癌放化疗患者行鼻咽操锻炼结合食物辅助锻炼,可减轻口腔黏膜炎和张口受限程度。     

白细胞介素-11雾化吸入治疗鼻咽癌同期放化疗导致口腔黏膜炎的疗效观察

目的：探讨白细胞介素-11（IL-11）雾化吸入治疗鼻咽癌同期放化疗导致口腔黏膜炎的临床疗效,为鼻咽癌同期放化疗导致口腔黏膜炎的治疗提供新方法。方法选取2010年4月～2013年6月间于我院肿瘤科住院治疗的初诊为鼻咽癌的患者84例,于放疗后2周即药物雾化吸入前,及放疗第3～7周观察口腔黏膜反应变化情况;于放疗结束后1周,观察口腔黏膜反应愈合情况,对比分析IL-11雾化吸入对鼻咽癌同期放化疗导致口腔黏膜炎的治疗效果。结果两组患者放疗后第2周均出现口腔黏膜反应,但观察组患者的口腔黏膜反应分级与对照组相比无显著变化,但随着放射治疗的持续以及放射剂量的增加,观察组患者的口腔黏膜反应分级以Ⅰ～Ⅱ度黏膜反应为主,而对照组患者的口腔黏膜反应分级以Ⅱ～Ⅲ度黏膜反应为主,两组患者组间比较发现,观察组患者的口腔黏膜反应程度较对照组显著增加（P＜0.05）;放疗结束1周后,观察组对于口腔黏膜炎治疗的总有效率为90.5%,与对照组相比显著升高（x2=27.064,P=0.000）。结论 IL-11雾化吸入能够有效减轻鼻咽癌同期放化疗导致口腔黏膜反应的程度,对于口腔黏膜炎的治疗具有促进作用。     

Chemotherapy with or without radiotherapy in patients with locoregionally recurrent nasopharyngeal carcinoma

BACKGROUND: Treatment of locoregionally recurrent nasopharyngeal carcinoma (NPC) is challenging because of prior radiotherapy, morbidities from disease recurrence, and limited therapeutic options available. METHODS: A retrospective study of patients with locoregionally recurrent NPC. RESULT: Between March 1994 and December 1999, there were 42 patients; most were Chinese (98%) men (81%) with undifferentiated NPC (86%). A repeat course of radiotherapy was feasible in 20 patients and given concurrently with cisplatin followed by adjuvant cisplatin/5-fluorouracil (PF) (group 1). The remaining 22 (group 2) received palliative chemotherapy (PF) with a response rate of 50%. Significant morbidities resulted from cranial nerve palsies. The 2-year progression-free survival of patients in group 1 was expectedly better (58% vs 38%). Six (14%) developed systemic metastases at 12 months (median) from first recurrence. CONCLUSION: Concurrent chemoradiotherapy for locoregional recurrent NPC seems promising. The morbidity experienced resulted from locoregional disease with few progressing to develop systemic involvement.     

食物辅助锻炼对鼻咽癌放化疗患者康复的作用

目的探讨食物辅助锻炼对促进鼻咽癌放化疗患者康复的可行性及有效性。方法将100例鼻咽癌放化疗患者按病房分为对照组和观察组各50例。对照组采用常规的9步鼻咽操锻练,观察组在此基础上增加食物辅助锻炼。结果放化疗治疗期间观察组口腔黏膜炎显著轻于对照组,放化疗后1年观察组张口困难程度显著低于对照组(均P0.01)。结论鼻咽癌放化疗患者行鼻咽操锻炼结合食物辅助锻炼,可减轻口腔黏膜炎和张口受限程度。     

Treatment of profuse epistaxis in patients irradiated for nasopharyngeal carcinoma

BACKGROUND: Profuse epistaxis in patients with nasopharyngeal carcinoma (NPC) previously treated with radiotherapy (RT) can be life threatening. Surgical means to prevent rebleeding may at times be difficult and unsuccessful. We aim to investigate the characteristics of this group of patients and our experience of endovascular embolization technique in the management of epistaxis in this group of patients. METHODS: A retrospective review of all nasopharyngeal carcinoma patients presented with profuse epistaxis during follow up after radiotherapy was carried out in a regional neurosurgical centre in Hong Kong. Seventeen patients were included for the analysis within the recent 6-year period. The age of patients was 55.5 +/- 8.358 years (mean +/- standard deviation). The sex ratio was 5:1 (M : F). Diagnostic catheter angiography was carried out in all 17 patients. Endovascular embolization was carried out in 11 patients with the joint decision of the otolaryngologist and neurointerventionist in charge . RESULTS: Four patients underwent main trunk occlusion for internal carotid pseudoaneurysm. Seven patients underwent embolization of branches of external carotid artery. One patient required another session of external carotid artery embolization 1 month later. There was one inpatient death because of pneumonia and hepatic encephalopathy. With our protocol, there were only two patients (11.7%) with delayed rebleed at 2 and 5 months, respectively. Both patients had advanced diseases and died. CONCLUSION: In irradiated patients with nasopharyngeal carcinoma presenting with profuse epistaxis, angiography had a high yield of pseudoaneurysm or hypervascularity and these lesions could be safely managed through endovascular embolization.     

Treatment results of 1070 patients with nasopharyngeal carcinoma: an analysis of survival and failure patterns

BACKGROUND: The aim of this analysis was to evaluate the outcomes of patients with nasopharyngeal carcinoma (NPC) treated primarily by external beam irradiation (ERT) and to explore for possible ways to improve the treatment results. METHODS: One thousand seventy patients with nonmetastatic NPC treated from 1990 to 1998 were retrospectively analyzed. The distribution according to the Union Internationale Contre le Cancer (UICC) (1997 edition) staging system at initial diagnosis was as follows: stage I, n = 113; stage IIA, n = 38; stage IIB, n = 360; stage III, n = 306; stage IVA, n = 136; stage IVB, n = 117; T1, n = 284; T2a, n = 88; T2b, n = 398; T3, n = 149; T4, n = 151; N0, n = 321; N1, n = 393; N2, n = 238; N3a, n = 29; N3b, n = 89. Two hundred eight patients were given neoadjuvant chemotherapy. Ninety-seven patients were diagnosed with locally persistent disease and were salvaged with high dose rate intracavitary brachytherapy. Multivariate analysis was performed with the Cox regression proportional hazards model. RESULTS: The 5-year actuarial local failure-free survival, regional failure-free survival, distant metastasis-free survival, progression-free survival, cancer-specific survival, and overall survival rates were 80.9%, 93.3%, 77.2%, 62.7%, 71.4%, and 66.5%, respectively. Isolated distant metastasis occurred in 191 patients (18%). The distributions were as follow: stage I, 2.1% (two of 95); stage IIA, 5.7% (two of 35); stage IIB, 14.9% (45 of 302); stage III, 26.4% (62 of 235); stage IVA, 40% (40 of 100); stage IVB, 47.1% (40 of 85). Results of the multivariate analysis of various clinical endpoints were discussed. By studying these failure patterns, it is hoped that we could refine future treatments according to the failure patterns of patients with different risks of locoregional and distant failure. CONCLUSIONS: The 18% incidence of isolated distant metastasis is too high to be ignored. Maximizing the local control and minimizing the risk of distant metastasis and late complications should be the key objectives in designing future clinical trials.     

血液肿瘤患者化疗相关性口腔黏膜炎的护理研究进展

对血液肿瘤患者化疗相关性口腔黏膜炎的危险因素和预防措施进行综述,危险因素包括个体因素、吸烟、口腔环境、口腔清洁度、血常规和肝肾功能检查结果、肿瘤类型、化疗药物种类及使用方法,预防口腔黏膜炎发生的措施包括化疗前口腔检查与清洗、有效刷牙与漱口、选择合适的漱口液、采用口腔冷冻疗法和低强度激光治疗、健康教育,今后可建立口腔黏膜炎的风险预测模型,以识别高风险人群,并采用多学科联动及综合性护理干预,以有效防治口腔黏膜炎发生。