鼻咽癌患者放射性口腔黏膜损伤的护理分析

目的探讨鼻咽癌患者放疗期间放射性口腔黏膜损伤的护理效果。方法选择本院2010年10月—2013年10月收治的100例鼻咽癌患者,随机分为对照组和观察组,每组50例,分别实施常规护理和舒适护理。观察两组患者护理后口腔黏膜损伤情况。结果放射治疗第5周,两组患者均出现口腔黏膜炎,观察组患者出现口腔黏膜损伤的时间迟于对照组。第1～4周,两组患者口腔黏膜炎的发生率比较,差异有统计意义（P〈0.05）。放射治疗第7周末,观察组患者口腔黏膜损伤在Ⅲ级和Ⅳ级的发生率低于对照组,差异有统计学意义（P〈0.05）。结论对鼻咽癌患者实施舒适护理,可以显著减少和延缓患者放射性口腔黏膜损伤的发生,且有效降低患者口腔黏膜损伤程度。     

四联混合液在鼻咽癌放射性口腔黏膜溃疡的临床应用

目的：探讨四联混合液口腔护理鼻咽癌患者放疗口腔黏膜反应的疗效。方法：本课题选用60例均采用直线加速器放疗的鼻咽癌产生口腔黏膜反应患者,随机分为治疗组和对照组,每组30例,对照组在放疗期间给予常规口腔护理,每日放疗前后及进食后采用0.9%氯化钠溶液配合庆大霉素含漱,必要时遵医嘱给予对症处理;治疗组除常规口腔护理外,从放疗第1天开始采用四联混合液含漱,进行疗效对照和评价。结果：经观察两组护理后的疗效,放疗结束后按RGOT急性放射性口咽黏膜损伤分级及疼痛的VAS评分方法进行临床评价,两组比较差异有统计学意义（P〈0.05）。结论：四联混合液能有效减轻鼻咽癌放疗患者的口腔黏膜反应,减轻患者痛苦,使放射治疗顺利进行。     

重组人表皮生长因子联合氨磷汀治疗鼻咽癌患者放射性口腔黏膜炎的临床观察

目的:观察重组人表皮生长因子外用溶液联合注射用氨磷汀治疗鼻咽癌患者放射性口腔黏膜炎的临床效果。方法:选取2013年8月-2014年8月在我院放疗科接受治疗的96例鼻咽癌患者为研究对象,按随机数字表法分为观察组和对照组各48例。对照组于每次放疗前15~30 min静脉滴注注射用氨磷汀,200 mg/m2,10 min内滴注完毕;观察组在对照组治疗基础上,加用重组人表皮生长因子外用溶液喷洒于口腔黏膜表面。比较两组患者放射性口腔黏膜炎程度、口腔黏膜疼痛程度、NRS2002营养风险评分及营养不良风险率的差异。结果:放疗期间,观察组患者放射性口腔黏膜炎及口腔黏膜疼痛程度均轻于对照组,差异具有统计学意义(P<0.05)。放疗结束后,观察组患者NRS2002营养风险评分及营养不良风险率均低于对照组,差异具有统计学意义(P<0.05)。结论:重组人表皮生长因子联合氨磷汀治疗鼻咽癌放疗患者,可有效降低放射性口腔黏膜炎发生率,减轻口腔黏膜疼痛,减少营养不良风险。     

鼻朗鼻腔喷雾器在鼻咽癌患者鼻腔冲洗中的应用

目的观察鼻朗鼻腔喷雾器应用于鼻咽癌患者鼻腔冲洗的效果。方法将90例鼻咽癌患者随机分为观察组46例和对照组44例。对照组采用一次性鼻腔冲洗机冲洗鼻腔,观察组采用鼻朗鼻腔喷雾器冲洗鼻腔。观察2组冲洗鼻腔后口腔黏膜反应的发生率。结果观察组Ⅱ级及其以上黏膜反应发生率低于对照组,差异有统计学意义(P<0.05)。结论鼻朗鼻腔喷雾器对防治放射性口腔黏膜反应有良好效果,对减轻患者疼痛、顺利完成放疗计划起到了积极的作用,其使用简单、方便、疗效确切、无不良反应,值得临床推广应用。     

阿米福汀联合同步放化疗治疗局部晚期鼻咽癌患者的临床研究

目的观察阿米福汀联合同步放化疗治疗局部晚期鼻咽癌患者的临床疗效及毒副反应。方法40例局部晚期鼻咽癌患者随机分为对照组及观察组,每组20例。两组患者均接受同步放化疗的综合治疗,放疗采用全程调强放疗IMRT技术。放疗同时予2个周期PF方案化疗,21 d为1个周期;放疗结束后继续完成2个周期PF方案化疗,共4个周期。同时,观察组联合应用细胞保护剂阿米福汀,1次/d静滴,每周一、周三、周五放疗前各1次。两组患者放疗期间每周化验血常规,每周观察及记录口腔内黏膜情况、唾液腺功能及放疗局部皮肤反应、消化道反应。放疗结束后3个月,评价全部患者的近期临床疗效。结果 40例患者均完成所有治疗,对照组和观察组的近期有效率RR分别为80%和90%,差异无统计学意义(χ~2=0.196,P>0.05)。毒副反应方面,观察组在放射性黏膜炎、急性口干及血液学毒性方面明显低于对照组,差异有统计学意义(P<0.05)。结论阿米福汀联合同步放化疗治疗局部晚期鼻咽癌,可降低患者的毒副反应,且不影响疗效,值得临床推广。     

五倍子水煎剂对鼻咽癌放疗所致口腔黏膜反应的疗效观察

目的观察五倍子水煎剂对于减轻鼻咽癌放射治疗所导致的口腔黏膜反应的治疗效果。方法将70例接受鼻咽癌放疗的患者随机分成2组,对照组和治疗组各35例,观察组用五倍子水煎剂每日口腔含漱7次,时间点分别为3餐的餐前、餐后和睡前,对照组采用生理盐水混合剂于3餐的餐前、餐后和睡前7个时间进行口腔含漱。如果两组有疼痛严重的患者,需进行抗炎治疗。观察比较两组患者在放疗第4周末、第8周末的口腔黏膜损伤程度和疼痛程度。结果两组患者在放疗后的第4周末和第8周末检查口腔黏膜损伤程度和疼痛程度,发现两组患者存在显著性差异,P<0.05。治疗组患者的口腔黏膜损伤程度和疼痛程度都远低于对照组。结论使用五倍子水煎剂治疗鼻咽癌放疗所致的口腔黏膜损伤,可以减少损伤程度和疼痛程度。     

冰块口腔降温防治放射性口腔黏膜损伤的临床研究

目的观察冰块口腔降温防治放射性口腔黏膜损伤的疗效。方法 60例头颈部恶性肿瘤患者,随机分成两组：治疗组和对照组各为30例。对照组：患者放疗开始后均行常规口腔护理,III、IV级黏膜损伤患者均予以静脉营养支持治疗。治疗组：在上述基础上,全部患者均于放疗摆位时口腔内放入一块冰块,至每次放疗结束。根据RGOT急性放射性黏膜损伤分级标准及疼痛的VAS评分进行临床评价。结果两组患者均发生程度不等的急性放射性口腔黏膜损伤;两组间黏膜损伤出现的时间比较差异有统计学意义（P〈0·05）;治疗组以I、II级口腔黏膜损伤为主（73·33%）;对照组以III、IV级黏膜损伤为主（63·33%）,两组间比较差异有统计学意义（P〈0·05）。治疗组以轻度疼痛为主（VAS评分0-3分,60·00%）,对照组以中度疼痛为主（VAS评分4-6分,46·67%）,两组间比较差异有统计学意义（P〈0·05）。结论冰块口腔降温可推迟放射性黏膜损伤的发生,并降低III、IV级黏膜损伤的发生率。     

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(P0.05);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。     

护理干预减轻鼻咽癌放疗不良反应的效果观察

目的观察护理干预对减轻鼻咽癌放疗期间急性放疗反应口腔黏膜炎和慢性放疗反应张口困难的临床效果：方法将80例鼻咽癌首次放疗患者随机分为观察组和对照组各40例。对照组实施常规护理，观察组在常规护理的基础上，进行系统的护理干预。结果观察组口腔黏膜反应轻于对照组，比较第4周、第6周两组口腔黏膜反应发生情况差异显著（P〈0．01）；随着放射剂量的累加，观察组张口困难的发生率低于对照组、程度轻于对照组，比较第4周、第6周两组张口困难发生情况差异显著（P〈0．01）。结论系统的护理干预能有效地预防鼻咽癌放疗不良反应的发生，值得临床推广应用。     

微小核糖核酸-451a在人参养荣汤治疗鼻咽癌放射性黏膜损伤中的机制研究

目的：通过检测微小核糖核酸-451a(miR-451a)和富含半胱氨酸的分泌性酸性蛋白(SPARC)mRNA的表达,推断人参养荣汤治疗鼻咽癌(NPC)放射性黏膜损伤的疗效及作用机制。方法：选择2022年3月—2023年5月收治的鼻咽癌放射性口腔黏膜损伤患者30例作为观察组,选择同期健康者30例作为对照组。采用辨证论治拟人参养荣汤加减治疗,比较观察组治疗前后患者中医症候积分量表和口干程度、口咽疼痛程度、黏膜损伤程度。检测治疗前后患者血清miR-451a和SPARC mRNA表达水平。结果：人参养荣汤可以有效降低患者主症和次症严重程度、Ⅲ级和Ⅳ级口腔黏膜损伤程度、口咽疼痛程度以及口干程度,使患者血清中miR-451a表达下降,促进SPARC mRNA蛋白翻译增强(P<0.05)。治疗前后,miR-451a与中医症候积分均呈正相关(P<0.05)。结论：人参养荣汤对鼻咽癌放射性黏膜损伤具有一定的临床疗效,可降低miR-451a表达水平,升高SPARC mRNA表达水平;miR-451a抑制了SPARC mRNA的翻译,可为将来的中西医结合治疗提供理论依据。     

Protective effects of amifostine on ischemia-reperfusion injury of rat kidneys

Objectives:Amifostine is a drug which can eliminate free oxygen radicals that appear in the body after radiation or chemotherapeutic agent exposure. It is used to decrease the renal toxicity of cisplatin. The aim of this study was to determine the role of amifostine in warm ischemia kidney model for prevention of ischemia/reperfusion injury and also to find out the mechanism for prevention from ischemia/reperfusion injury if such an effect does exist.Results:At the 7^th day, blood urea nitrogen level was statistically significantly higher in ischemia-control group than all groups (P = 0.001) and mean serum creatinine levels were found to be the highest in ischemia-control group (P = 0.091). Mean malondialdehyde levels in left kidneys removed on the 7^th day were not significantly different (P = 0.105) at all three groups. Between ischemia-control group and amifostine group, there was a significant difference in reduced glutathione (GSH) levels (P = 0.001). In amifostine group, grade 4 necrosis was not detected neither on 7^th day nor day 0.Conclusion:Amifostine could decrease the degree and severity of necrosis after reperfusion. Amifostine could not prevent membrane lipid peroxidation caused by superoxide anion radicals in kidney but they could protect tissues from the harmful effects of ischemia/reperfusion injury by increasing the level of reduced GSH which is a well-known oxygen radical eliminator.KEY WORDS: Amifostine, ischemia-reperfusion injury, kidney     

Intraoral manganese superoxide dismutase-plasmid/liposome (MnSOD-PL) radioprotective gene therapy decreases ionizing irradiation-induced murine mucosal cell cycling and apoptosis

BACKGROUND: Single or multiple intraoral administrations of manganese superoxide dismutase-plasmid/liposomes (MnSOD-PL) to C3H/HeNHsd mice receiving single fraction or fractionated ionizing irradiation to the head and neck region have been shown to significantly decrease mucosal ulceration, weight loss and to improve survival. MATERIALS AND METHODS: To elucidate the mechanism of irradiation protection by MnSOD-PL and explore possible additive or synergistic protective effects with Amifostine (WR2721), mice received a single fraction of 19, 22.5, 25 or 30 Gy, or 24 fractions of 3 Gy irradiation to the oral cavity and oropharynx. Multiple parameters of irradiation-induced toxicity were quantitated in subgroups of each irradiated group of mice treated with single or multiple administrations of intraoral MnSOD-PL and/or intravenous WR2721. RESULTS: In 19 Gy single fraction irradiated mice, MnSOD-PL treatment the day before irradiation alone or in combination with intravenous WR2721 significantly decreased the irradiation induction of mucosal cell cycling as measured by 5-bromo-2-deoxyuridine (BuDR) uptake in oral cavity mucosal cells at 48 hours and decreased ulceration of the tongue at nine days after irradiation compared to control, irradiated or irradiated, WR2721-treated mice. Mice treated in single fractions of 22.5, 25 or 30 Gy showed MnSOD-PL protection against irradiation-induced oral mucosal apoptosis and xerostomia measured in decreased saliva output. In fractionated irradiated mice, twice weekly hemagglutinin (HA) epitope-tagged MnSOD uptake in oral cavity and tongue mucosal cells was not detectably altered by daily WR2721 intravenous administration. Mice treated with both radioprotective agents (MnSOD-PL and WR2721) demonstrated a significant decrease in irradiation-induced xerostomia (measured as reduced salivary gland output volume), mucosal ulceration and improved survival. CONCLUSION: Enhanced salivary gland function in WR2721-treated mice in the absence of detectable mucosal protection, coupled with relatively low uptake of HA-MnSOD in the salivary glands of intraorally-treated mice, suggests that a combination of both radioprotective agents may prove optimally effective for the prevention of the acute and late normal tissue toxicities of fractionated radiotherapy for head and neck cancer.     

氨磷汀对淋巴瘤化疗病人重要脏器保护作用临床观察

目的 观察氨磷汀（阿米福汀）对淋巴瘤化疗病人重要脏器保护作用及药物不良反应和安全性。方法 16例恶性淋巴瘤病人均接受单纯化疗（对照组）及化疗加阿米福汀（治疗组）两种方案治疗，作自身前后对照研究。化疗前后监测肝功能、肾功能、心功能及血常规、血钙浓度。结果 化疗相关肝功能损害对照组出现11例，治疗组出现2例（P〈0．01）；肾功能损害仅见对照组出现4例，心功能损害仅见对照组出现1例，治疗组未出现心肾功能损害（P〉0．05）；化疗后发生粒细胞缺乏症对照组11例，治疗组4例（P〈0.01）。结论 阿米福汀能明显减少化疗相关肝功能损害的发生，减少化疗后粒细胞缺乏症的发生。阿米福汀不良反应少见，主要是恶心呕吐、短暂的低血钙症。     

Effect of cevimeline on salivary components in patients with Sjögren syndrome

The aim of this study is to clarify the effects of cevimeline on various components in human saliva, such as immunoglobulin A (IgA), lysozyme, alpha-amylase and squamous cell carcinoma (SCC) antigen. Twelve female patients with Sj?gren syndrome (SS) and 14 healthy women were enrolled. After the first saliva collection, one capsule (30 mg) of cevimeline was administered to each subject. Saliva was collected again after 90 min. The salivary flow rate and concentration of each component were measured. In both groups the salivary flow rate and amylase concentration were significantly increased by cevimeline. The lysozyme and IgA concentrations did not change significantly in both groups. The SCC antigen concentration did not change significantly in the SS group, but it decreased significantly in the control group. The secretion rates of amylase and IgA showed significant increases in both groups. The secretion rate of lysozyme significantly increased only in the control group, while the secretion rate of SCC significantly increased only in the SS group. Cevimeline augments not only the salivary flow rate but also the secretion rate of some digestive and/or defense factors from infections. It may be beneficial for SS patients to continue taking cevimeline to prevent oral infections, and other serious sequelae.     

口腔小涎腺肿瘤87例临床分析

目的探讨口腔小涎腺肿瘤的临床诊治特点。方法对本科1 9 9 5~2 0 0 5年经病理确诊的8 7例口腔小涎腺肿瘤的临床资料进行回顾性分析。结果 8 7例口腔小涎腺肿瘤,良性肿瘤6 2例,占7 1.2 6%;恶性肿瘤2 5例,占2 8.7 4%。良性肿瘤均为混合瘤,恶性肿瘤中以腺样囊性癌多见,占恶性肿瘤的4 4.0 0%,8 7例均行手术治疗,恶性肿瘤5年生存率为8 8.8 2%。结论口腔小涎腺肿瘤中良性肿瘤多于恶性肿瘤。外科手术是口腔小涎腺肿瘤的主要治疗方法,恶性肿瘤可行手术＋术后辅助放疗的综合治疗。     

注射用氨磷汀安全性研究

目的研究注射用氨磷汀的安全性,为临床应用提供依据。方法进行豚鼠全身主动过敏试验(ASA),首先隔日每只豚鼠每次腹腔注射供试品,共3次,再于首次注射后第14日和第21日由耳缘静脉注射供试品,观察动物过敏反应;进行大鼠被动皮肤过敏试验(PCA),大鼠皮内注射抗体血清,静脉注射伊文思蓝,观察蓝色反应斑;进行体外溶血试验,观察供试品在3h内有无溶血和凝聚现象;进行血管刺激试验,家兔连续5 d耳缘静脉注射供试品,观察其对注射局部血管的刺激。结果注射用氨磷汀豚鼠全身主动过敏性试验及大鼠被动皮肤过敏性试验均未见过敏反应;体外溶血试验在3 h内未见溶血和凝聚现象;血管刺激性试验病理组织学检查未见血管刺激性反应。结论注射用氨磷汀安全、可靠。     

阿托品防治腮腺肿物区域切除术后涎瘘的疗效观察

目的探讨阿托品防治腮腺肿物区域切除术后涎瘘的疗效。方法随机选择口腔科腮腺肿物区域切除术后无明显其他全身疾患的患者40例分成两组,治疗组的患者20例给予阿托品片三餐前半小时口服,对照组患者20例无口服阿托品,所有40例患者均术后加压包扎,7d后观察患者术区涎瘘情况。结果治疗组疗效优于对照组,两者差别有统计学意义（P〈0.05）。结论阿托品防治腮腺肿物区域切除术后涎瘘的疗效不可忽视,具有良好的临床应用效果。     

Alternate delivery route for amifostine as a radio-/chemo-protecting agent

Amifostine (ethiofos, WR-2721) is an organic thiophosphate prodrug that serves as an antineoplastic adjunct and cytoprotective agent useful in cancer chemotherapy and radiotherapy. The selective protection of certain tissues of the body is believed to be due to higher alkaline phosphatase activity, higher pH and vascular permeation of normal tissues. Amifostine is conventionally administered intravenously before chemotherapy or radiotherapy. It is approved by the Food and Drug Administration (FDA) to reduce cumulative renal toxicity associated with repeated administration of cisplatin in patients with advanced ovarian cancer. It was originally indicated to reduce the cumulative renal toxicity from cisplatin in non-small cell lung cancer although this indication was withdrawn in 2005. Amifostine is also FDA approved for patients with head and neck cancer to reduce the incidence of moderate to severe xerostomia in patients who are undergoing postoperative radiation treatment where the radiation port includes a substantial portion of the parotid glands. The potential of amifostine as a cytoprotective agent is unlikely to be fully realized if the method of administration is restricted to intravenous administration. Attempts have been made to develop non-invasive methods of delivery such as transdermal patches, pulmonary inhalers, and oral sustained-release microspheres. It is the goal of this article to explore non-intravenous routes of administration associated with better efficacy of the drug. This review will primarily focus on the variety of more recently studied (2002 and later) alternative modes for amifostine administration, including subcutaneous, intrarectal and oral routes.     

Botulinum Toxin A for Oral Cavity Cancer Patients: In Microsurgical Patients BTX Injections in Major Salivary Glands Temporarily Reduce Salivary Production and the Risk of Local Complications Related to Saliva Stagnation

In patients suffering from oral cavity cancer surgical treatment is complex because it is necessary to remove carcinoma and lymph node metastasis (through a radical unilateral or bilateral neck dissection) and to reconstruct the affected area by means of free flaps. The saliva stagnation in the post-operative period is a risk factor with regard to local complications. Minor complications related to saliva stagnation (such as tissue maceration and wound dehiscence) could become major complications compromising the surgery or the reconstructive outcome. In fact the formation of oro-cutaneous fistula may cause infection, failure of the free flap, or the patient’s death with carotid blow-out syndrome. Botulinum injections in the major salivary glands, four days before surgery, temporarily reduces salivation during the healing stage and thus could reduce the incidence of saliva-related complications. Forty three patients with oral cancer were treated with botulinum toxin A. The saliva quantitative measurement and the sialoscintigraphy were performed before and after infiltrations of botulinum toxin in the major salivary glands. In all cases there was a considerable, but temporary, reduction of salivary secretion. A lower rate of local complications was observed in the post-operative period. The salivary production returned to normal within two months, with minimal side effects and discomfort for the patients. The temporary inhibition of salivary secretion in the post-operative period could enable a reduction in saliva-related local complications, in the incidence of oro-cutaneous fistulas, and improve the outcome of the surgery as well as the quality of residual life in these patients.     

结肠癌术后早期肠内营养的应用价值

目的探讨结肠癌术后早期肠内营养（EN）的临床应用价值。方法93例结肠癌患者按入院单双号分为EN组（57例）和肠外营养组（PN组,36例）,EN组于结肠癌术后24h内开始经空肠营养管滴人肠内营养制剂并逐步减少静脉营养支持,PN组于结肠癌术后每日行完全肠外静脉营养支持,直到经口进食。观察两组胃肠功能恢复时间、营养状况及血清C-反应蛋白水平变化情况。结果两组术后营养状态指标均较术前明显下降,但两组间差异无统计学意义（P〉0．05）;EN组肛门排气时间、排便时间分别为（52．9±17．6）h和（67．2±9．3）h,与PN组的（71．4±13．8）h和（83．6±10．1）h相比较,差异均有统计学意义（t=2．58、3．56,均P〈O．05）;术后7dEN组C-反应蛋白水平（19．3±2．2）mg／L明显低于PN组的（27．8±2．3）mg／L（t=4．12,P〈0．05）。结论早期EN能降低结肠癌术后应激反应,促进胃肠功能的早期恢复。