多学科合作外科处理头颈部复杂肿瘤

目的：探讨多学科合作外科处理头颈部复杂肿瘤的经验,以提高临床治疗效果。方法：回顾分析1995年4月－2000年6月与神经外科等其他学科合作,外科治疗头颈肿瘤累及颅底,颅内或颈椎管内等相邻部位结构的22例患者临床资料。结果：本组良性肿瘤患者14例,获得肿瘤全切除;恶性肿瘤8例,5例达到肉眼全切除,3例得到减状治疗,无手术死亡和严重并发症病例,良性肿瘤患者平均随诊3例,肿瘤复发率为21．4％（3／14）,均为外院术后再治疗,8例恶性肿瘤患者随诊1年,3例无复发,2例带瘤生存,3例死亡。结论：对于复杂的头颈部肿瘤的外科治疗,应提倡多学科间的密切合作,可明显提高患者的治疗效果。     

慢性肝衰竭患者基于营养风险等级的多学科营养管理

目的 探讨基于营养风险等级的多学科营养管理在慢性肝衰竭患者的应用效果.方法 按入院时间顺序,纳入2020年4～8月的51例患者作为对照组,采用常规营养护理;2020年9月至2021年3月的52例作为干预组,实施基于营养风险等级的多学科营养管理方案.比较两组干预前后营养不良风险筛查评分、Child-Pugh评分和营养相关...     

个体化营养护理对头颈部肿瘤放化疗患者的应用效果

目的 探讨个体化营养护理对头颈部肿瘤放化疗患者的应用效果。方法 选取2018年5月至2018年12月在我科行头颈部肿瘤放化疗患者104例,按入院时间分为对照组和观察组,每组52例。对照组采用欧洲营养风险筛查2002（NRS-2002）评估患者营养状况进行常规指导,观察组在对照组的基础上根据NRS-2002评估结果结合电话、微信随访实施个体化营养护理。放化疗结束7天后观察比较两组患者的营养状况指标、并发症发生率、住院日及住院总费用比较的差异。结果 放化疗结束7天后,观察组患者营养状况指标明显优于对照组,差异均有统计学意义（P<0.05）,观察组患者并发症发生率较对照组低,差异均有统计学意义（P<0.05）,观察组患者住院日及住院总费较对照组低。结论 采用个体化营养护理对头颈部肿瘤放化疗患者,有效改善患者营养状况,降低并发症发生率,缩短住院日及降低住院总费。     

头颈部肿瘤放疗患者病服的设计与应用

目的 保护头颈部放疗患者放射野皮肤,避免粗糙衣物机械摩擦患者颈部皮肤.方法 将100例头颈部肿瘤放疗患者随机分成观察组与对照组各50例.对照组着传统病服接受放疗,观察组着自行设计的3款不同衣袖的圆领病服,即无袖、短袖和长袖病服(根据季节变化穿戴不同款式)接受放疗.结果 观察组放射性皮炎严重程度显著轻于时照组.患者舒适度显著高于对照组(P＜0.05,P＜0.01).结论 圆领病服可避免衣领与颈部放射野皮肤的摩擦,消除引起或加重放射性皮炎的机械摩擦,从而避免或减轻放射性皮炎的发生,提高患者的舒适度.     

头颈部肿瘤放疗患者病服的设计与应用

目的保护头颈部放疗患者放射野皮肤，避免粗糙衣物机械摩擦患者颈部皮肤。方法将100例头颈部肿瘤放疗患者随机分成观察组与对照组各50例。对照组着传统病服接受放疗，观察组着自行设计的3款不同衣袖的圆领病服，即无袖、短袖和长袖病服（根据季节变化穿戴不同款式）接受放疗。结果观察组放射性皮炎严重程度显著轻于对照组，患者舒适度显著高于对照组（P〈0．05，P〈0．01）。结论圆领病服可避免衣领与颈部放射野皮肤的摩擦，消除引起或加重放射性皮炎的机械摩擦，从而避免或减轻放射性皮炎的发生，提高患者的舒适度。     

头颈部肿瘤患者放疗期间口腔健康行为的纵向调查

目的了解头颈部肿瘤患者放疗期间的口腔健康行为,为改进临床实践提供依据。方法使用自制的口腔健康行为问卷,对104例头颈部肿瘤患者在放疗第1周(入院时)、第2周、第4周、出院时进行调查;并每周检测患者是否发生口腔黏膜炎。结果至放疗第5周,所有患者均发生口腔黏膜炎;患者口腔健康行为除"使用牙线"不同时间点比较差异无统计学意义(P0.05)外,其余6项口腔健康行为放疗期间均有所改善(P0.05,P0.01);年龄对治疗期间口腔健康行为有影响(P0.05),性别及学历对入院时的口腔健康行为影响有统计学意义(均P0.05),之后影响无统计学意义(均P0.05)。结论头颈部肿瘤患者放疗期间口腔黏膜炎发生率高;口腔健康行为(除使用牙线外)在入院后有所改善。医护人员需关注头颈部肿瘤放疗患者的口腔健康行为,尤其是对年长者;制定基于循证证据的口腔照护策略,以改善患者的口腔健康行为。     

多学科协作干预对宫颈癌放疗患者生活质量的影响

目的探讨多学科协作干预对改善宫颈癌放疗患者生活质量的效果。方法将2017-04—2017-06郑州大学第二附属医院收治的45例宫颈癌放疗患者作为对照组,给予常规护理。将2017-07—2017-09收治的45例宫颈癌放疗患者作为观察组,给予多学科协助干预。比较2组护理效果。结果干预后,观察组宫颈癌量表总分及各个维度得分均高于对照组,自我效能水平、并发症发生率均优于对照组,差异有统计学意义(P0.05)。结论多学科协助干预能增强宫颈癌放疗患者的自我效能水平,降低并发症发生率,提高生活质量,改善治疗效果。     

头颈部肿瘤放疗功能锻炼健康教育处方的设计与应用

目的减少头颈部肿瘤患者放疗并发症发生率。方法对89例头颈部肿瘤患者采用自行设计的头颈部肿瘤功能锻炼健康教育处方,实施功能锻炼方法的讲解与示范。结果89例患者均掌握功能锻炼方法,完成放疗疗程,未发生舌、咀嚼肌功能减退,牙龈萎缩,张口困难等并发症。张口高度54例无变化;31例缩小0.05～0.09cm。结论健康教育处方的设计与应用,有效减少了放疗并发症的发生,保证了放疗的实施。     

护士主导的多学科协作鼻咽癌同步放化疗患者营养管理

目的 改善鼻咽癌患者放化疗期间的营养状况及其放化疗不良体验.方法 将74例鼻咽癌患者按住院时间分为对照组36例和观察组38例.两组均行根治性调强放疗加同期化疗,行常规临床护理;对照组实施常规营养管理,观察组实施由护士主导的多学科团队协作的营养管理.放化疗疗程完成后(7周)评价效果.结果 放化疗完成后观察组PG-SGA评...     

多学科团队协作营养管理模式在腹膜透析患者中的应用

目的 对腹膜透析患者实施多学科协作营养管理,以改善其营养状况。方法 根据患者入院时间将首次置管行腹膜透析患者分为两组,2018年1~5月收治的42例患者为对照组,按腹膜透析管理流程实施常规护理,由腹膜透析护士负责腹膜透析治疗、营养管理、延续护理等;2019年1~5月收治的45例患者为干预组,组建多学科营养管理团队,实施多学科协作营养管理。结果 干预组出院后1个月和6个月血红蛋白、血清白蛋白、血清总铁结合力、BMI、上臂肌围及营养不良炎症评分显著优于对照组,蛋白质-能量营养不良发生率显著低于对照组（P＜0.05,P＜0.01）。结论 对腹膜透析患者进行多学科协作营养管理,能有效改善腹膜透析患者营养水平,并能够强化护士在营养管理过程中的作用。     

Health education prescription for functional exercise targeted to head and neck cancer patients receiving radiotherapy

目的 减少头颈部肿瘤患者放疗并发症发生率.方法 对89例头颈部肿瘤患者采用自行设计的头颈部肿瘤功能锻炼健康教育处方,实施功能锻炼方法的讲解与示范.结果 89例患者均掌握功能锻炼方法,完成放疗疗程,未发生舌、咀嚼肌功能减退,牙龈萎缩,张口困难等并发症.张口高度54例无变化;31例缩小0.05～0.09 cm.结论 健康教育处方的设计与应用,有效减少了放疗并发症的发生,保证了放疗的实施.     

对头颈癌放疗患者实施营养相关症状管理教育的效果研究

目的 探讨症状管理教育对头颈癌放疗患者营养相关症状水平和营养状况的影响。 方法 将128例头颈癌放疗患者按不同病区分为对照组与干预组各64例;对照组实施放疗常规护理,干预组在对照组基础上增加分阶段持续性症状管理教育。分别在放疗第1、4、7周和放疗后1个月应用头颈患者症状清单进行营养相关症状评估,同时测量体质量、血清白蛋白及血红蛋白。 结果 干预组不同时间点营养相关症状总分及疼痛、恶心和抑郁严重程度显著低于对照组,体质量、血清白蛋白、血红蛋白显著高于对照组（干预主效应均P＜0.05）。 结论 分阶段持续性症状管理教育能够提高头颈癌放疗患者的症状管理能力,有效减轻患者营养相关症状负荷,改善患者营养状况。     

Pilot study of positron emission tomography in patients with advanced head and neck cancer receiving radiotherapy and chemotherapy

Background. Positron emission tomography (PET) provides a noninvasive modality for evaluating the biochemical processes of normal and pathologic tissue. Preliminary reports of F-18 fluorodeoxyglucose (FDG) PET indicate its potential usefulness in evaluating head and neck tumors. The current study was performed to explore the relationship between changes in tumor FDG metabolism and local control in patients receiving hyperfractionated radiotherapy and concurrent chemotherapy. Methods. The study group consisted of six patients with locally advanced, nonmetastatic squamous cell carcinoma of the head and neck. FDG studies were performed prior to, during, and 24 months post-therapy. Ratios of tumor to nontumor FDG uptake in regions of interest (ROI) were compared. Results. All pretherapy studies demonstrated a focal hypermetabolic abnormality corresponding to the known tumor. The pretherapy tumor to nontumor FDG ratios declined significantly during therapy (p < 0.05) with a similar continued trend post-therapy (p < 0.07). Conclusion. The treatment-induced decrease in tumor hypermetabolism as seen on serial FDG PET parallels the clinical response in squamous carcinoma of the head and neck. Two-year follow-up scans also suggest that continued low tumor to nontumor ratios reflect eradication of local disease. Because of its high cost, a study of larger numbers of patients is necessary to better define the role of PET in the management of head and neck cancer. © 1994 John Wiley & Sons, Inc.     

Intraoperative radiotherapy in patients with recurrent head and neck cancer

Patients with head and neck cancer who have a relapse of the disease above the clavicles can sometimes be salvaged by additional surgery. However, if all gross tumor cannot be removed during surgery or if the resection margins are unsatisfactory, the likelihood of salvage is remote, especially when postoperative radiotherapy is not feasible due to previous radiotherapy. Between 1979 and 1983, we employed intraoperative brachytherapy for 21 such patients. Sixteen patients had a recurrence after previous surgery and radiotherapy, and 5 after radical radiotherapy. All gross tumor could not be removed in 15 patients, whereas satisfactory margins could not be obtained in 6. In 11 patients, we delivered radiotherapy by a temporary implant of iridium-192 (median dose 4,800 rads in 6 days). In 10 patients, radiotherapy was delivered by a permanent implant of iodine-125 (median activity 13 mCi). Three patients (14 percent) had a relapse within the surgical field, whereas six others (28 percent) had a relapse elsewhere or had development of metastases. Complications developed in four patients (19 percent) and were fatal in one patient. The actuarial disease-free survival rate at 2 years was 55 percent, whereas the rate of local disease control was 81 percent. Our experience suggests that intraoperative brachytherapy can salvage certain high-risk patients with head and neck cancer.     

开展品管圈活动减轻头颈部肿瘤患者放射性皮肤损伤

目的 探讨开展品管圈对减轻头颈部肿瘤患者放疗所致皮肤损伤的作用.方法 科室成立品管圈小组,以减轻头颈部肿瘤患者放疗所致的皮肤损伤为活动主题,通过现状调查,要因分析,拟定对策及实施等步骤开展品管圈活动.结果 品管圈实施后患者护理知识知晓率由实施前的88.7％提高到96.2％,护理服务满意度由89.6％提高到99.1％;患者皮肤损伤分级情况实施后显著优于实施前(P＜0.05,P＜0.01).Ⅱ级及以上皮肤损伤发生率35.8％,低于目标值.结论 品管圈活动降低了头颈部肿瘤患者放疗所致皮肤损伤的程度,提高了其放疗护理知识知晓率和护理服务满意度.提出开展品管圈活动是护理质量持续改进的一种有效手段.     

Oral candidiasis in patients receiving radiation therapy for head and neck cancer

Objective

To investigate oral candidiasis in patients with head and neck cancer before, during, and after radiation therapy, and to explore its association with clinical oropharyngeal symptoms.

Study Design

A cohort study.

Setting

University hospital.

Subjects and Methods

Subjects who received radiation therapy (RT) for the treatment of head and neck cancer were divided into two groups: an oral cavity irradiated group (OIRR group, n = 29) and an oral cavity nonirradiated group (ONIRR group, n = 17). A control group consisted of 18 healthy subjects. Patients were examined for signs of oral candidiasis before, during, immediately after, and one month after RT. Mouth and throat soreness (MTS), dysphagia, and xerostomia were evaluated by self-reported questionnaires, and associations between oral candidiasis and these symptoms were analyzed.

Results

The incidence of oral candidiasis during RT was significantly higher in the OIRR group (55.2%) than in the ONIRR group (11.8%). Similarly, the occurrence of xerostomia during RT was significantly higher in the OIRR group (86.2%) than in the ONIRR group (52.9%). In the OIRR group, the mean MTS score at the 20th fraction of RT was significantly higher in patients with candidiasis (mean ± SD, 5.8 ± 2.1) than in those with RT-induced mucositis without candidiasis (3.7 ± 2.0). In the OIRR group, 65.2 percent of patients who experienced dysphagia developed oral candidiasis, compared with only 10 percent in the ONIRR group.

Conclusion

Oral candidiasis concurrent with oral mucositis due to RT may increase oropharyngeal discomfort during RT.