头颈部鳞癌放疗黏膜急性放射反应的护理

我科2002-05／2006-09共收治的头颈部鳞癌放疗患者113例，对放疗不良反应的预防和护理总结如下。     

头颈部肿瘤放疗中口腔黏膜急性反应的护理

目的 探讨头颈部肿瘤放疗中口腔黏膜急性反应的护理措施。方法 对28例头颈部肿瘤病人做放疗，总量70一80Gy／35—40次／7—8周，根据放疗后的反应程度进行相应的口腔护理和生活指导。结果通过治疗龋齿、口咽含漱、雾化吸入、口腔喷药、药物止痛、饮食调节、营养支持等方法，控制症状、减轻疼痛使病人顺利完成放疗。结论 对放疗病人细致的口腔护理及合理用药使反应程度降低，缩短黏膜修复时间，提高病人的生存质量。     

头颈部肿瘤患者放疗过程中的观察及护理对策

目的：探讨头颈部肿瘤患者放疗过程中存在的问题及护理对策。方法：对我科2002-06/2007-06 211例头颈部肿瘤患者放疗过程中的护理经过（包括心理护理、饮食指导、健康教育及一系列专科护理措施）进行回顾性分析总结。结果：211例患者顺利完成治疗过程。结论：头颈部肿瘤患者住院放疗期间切实有效的整体护理措施,可减少或避免放疗并发症,减轻患者痛苦,提高疗效,提高患者生活质量,避免不必要延长住院天数,减少患者费用。     

头颈部肿瘤38例放射治疗的护理

放射治疗是利用辐射能对生物组织作用后的临床效应来作为治疗恶性肿瘤的主要手段之一,头颈部肿瘤治疗首选放疗。在放疗过程中,常出现不同程度的放疗反应,不仅给患者带来痛苦,而且严重反应可使患者中断治疗。为使放疗顺利进行,应当做好各方面的临床护理工作,现将头颈部肿瘤放疗的护理介绍如下。     

头颈部肿瘤放疗引起口腔溃疡的护理

头颈部肿瘤包括鼻咽癌、口腔癌、上颌窦癌、喉癌、甲状腺癌等癌症，其治疗以放射治疗效果最佳。而口腔溃疡是头颈部肿瘤放疗后常见且具潜在危险性和缺乏有效防治手段的并发症，影响患者进食，造成营养缺乏、水电解质紊乱、低蛋白血症，阻碍患者接受进一步治疗。严重影响其生存质量，同时也是致死性感染的原因之一。因此，研究放射性口腔溃疡的预防和治疗具有重要的临床意义。这其中，护理有不可忽略的作用，现将护理体会汇报如下。     

饮食护理干预对头颈部肿瘤患者放疗期间营养状况的影响

目的 探讨饮食护理干预对头颈部肿瘤放疗患者营养状况的影响.方法 86例头颈部肿瘤放疗患者随机分为观察组与对照组各43例,对照组采用常规护理干预,观察组在此基础上采用及时饮食护理干预,在整个放射疗程中对两组患者体重等进行分析评估.结果 在放疗早期两组体重等指标差异无统计学意义;在放疗中、后期观察组体重等评价指标明显优于对照组.结论 有效的饮食护理干预可提高头颈部肿瘤放疗患者的营养状况,使患者对放疗不良反应的耐受性增强,保障放疗顺利完成.     

头颈部放疗护理指导卡的设计与应用

目的：最大程度减少头颈部肿瘤患者放疗不良反应特别是不可逆并发症的发生。方法将180例头颈部肿瘤放疗患者按住院时间先后分为对照组和观察组。对照组采用功能锻炼健康教育处方进行健康教育,观察组予头颈部放疗护理指导卡对患者及家属进行护理指导。结果对照组患者功能锻炼依从76例,不依从14例;观察组患者依从87例,不依从3例,差异有统计学意义（χ2＝7．86,P＜0．01）。观察组患者口腔黏膜溃疡、颈活动度与张口困难发生情况少于对照组,差异有统计学意义（ P＜0．05）。结论头颈部放疗护理指导卡可有效提高头颈部肿瘤放疗患者知识掌握程度、遵医行为和生存质量,减少放疗并发症的发生。     

头颈部肿瘤患者放疗反应的护理对策

头颈部肿瘤占全身恶性肿瘤的19．9％-30．2％，放射治疗是最有效的治疗方法，但其所导致的副反应严重影响患者的生活质量及放疗疗效，为保证放疗的顺利进行，我们采取了相应的护理措施，取得满意效果。1996年9月-2005年9月，我科住院治疗头颈部肿瘤患者116例，经护理，全部完成了全程放疗，现报道如下。     

头颈部恶性肿瘤急性放射反应的中西医结合护理

放射治疗鼻咽癌及其他头颈部恶性肿瘤仍然是目前最有效的治疗手段之一。但局部急性 全身反应常甩为暂停或中止放射治疗的原因。作者对３５例头颈部恶性肿瘤放射治疗的病人采取中西医结合的护理措施,在减轻和缓解胃肠道反应,口腔、鼻咽、咽喉等部位的粘膜反应,照射野皮肤反应等方面取得了满意效果,有利于放射治疗的顺利进行。     

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。     

立体聚焦支持护理在头颈部肿瘤放疗患者中的应用

目的 观察立体聚焦支持护理在头颈部肿瘤放疗患者中的应用效果.方法 将2016年1月至2016年6月收治于本院的头颈部放疗患者112例作为研究对象,随机分为对照组与试验组各56例,对照组接受常规放疗护理,试验组接受立体聚焦支持护理,比较干预后两组头颈部肿瘤放疗病例在各相关观察指标方面的差异.结果 试验组头颈部肿瘤放疗病例干预后的生活质量评分和护理满意度评分均显著高于对照组同类病例,差异有统计学意义(P<0.05).结论 采用立体聚焦支持护理对头颈部肿瘤放疗患者实施干预,在提升该类病例生活质量及护理满意度方面均具备积极效应.     

Lived experiences of eating problems for patients with head and neck cancer during radiotherapy

Only a small proportion of cancer patients undergo radical radiotherapy to the head and neck, but their needs are particularly complex. Although extensive research describes the side-effects of radiotherapy to the head and neck, few studies focus on patients' subjective experiences of eating problems and the impact these have on the patients' daily life. In this study a phenomenological approach was used, as the purpose was to acquire deeper understanding of head and neck cancer patients' lived experiences of eating problems, their consequences in daily life and patients' strategies of coping with these problems. Eight patients from two radiation therapy departments in mid-Sweden were interviewed in an open dialogue. Data analysis was based on Colaizzi's method. Eating problems experienced were captured in two interrelated main themes: "Ability to chew and swallow" and "Will and desire to eat". The eating problems were found to cause a number of severe consequences in daily life. These are incorporated into one main theme: "The way of life is disturbed". Ways to cope with this disturbance were captured in one main theme: "Trying to see the end - To survive". This study identifies the need to view eating problems as a complex phenomenon in a specific context including the individual patient's life situation. The findings create the opportunity to develop nursing interventions based on patients' own needs. To facilitate this, a specialist nurse should be responsible for reviewing patients regularly throughout radiation therapy. Intervention studies are needed to provide optimal clinical guidelines.     

功能与分子影像在头颈部肿瘤放射治疗计划和疗效评价中的应用

放射治疗是头颈部肿瘤主要治疗方法之一,随着医学影像学的不断发展,在CT等传统解剖影像基础上,功能影像与分子影像在头颈部肿瘤放射治疗计划制订和疗效评价中的价值正日益显现。本文综述了功能与分子影像在头颈部肿瘤放射治疗中的应用进展。     

血管回声跟踪技术评价头颈部肿瘤患者放疗后颈动脉弹性

目的:应用E-Tracking技术探讨头颈部肿瘤患者放疗后颈动脉弹性功能变化及其临床意义.方法:收集75例放疗后头颈部肿瘤患者(放疗组)及65例健康志愿者(对照组),比较两组颈动脉的参数变化;选择放疗组39例患者比较放疗前与放疗后的颈动脉参数变化;E-Tracking参数包括僵硬度(β)、弹性模型(Eρ)、顺应性(AC)、脉搏波传导速度(PWVβ)及内-中膜厚度(IMT).并对放疗组颈动脉损伤影响因素进行分析.结果:放疗组较对照组β、Eρ、PWVβ、IMT升高,AC降低,差异均有统计学意义(P＜0.05).与放疗前比较,放疗后β、Eρ、PWVβ值增高,AC降低,差异有显著性(P＜0.05),IMT比较无显著性差异(P＞0.05).经多因素Logistic回归分析发现年龄＞60岁、放疗间隔时间＞5年是头颈部肿瘤患者放疗后颈动脉损伤的危险因素.结论:头颈部肿瘤患者放疗后颈动脉弹性功能较正常人减低;E-Tracking参数能够早期反映颈动脉弹性功能的异常改变;年龄、放疗间隔时间是头颈部肿瘤患者放疗后颈动脉损伤的危险因素.     

头颈部肿瘤放射治疗口腔黏膜反应的防治进展

介绍了急性口咽黏膜反应的评定标准及中西药物治疗放射性口腔黏膜反应的研究进展。     

头颈部肿瘤放射治疗口腔黏膜反应的防治进展

介绍了急性口咽黏膜反应的评定标准及中西药物治疗放射性口腔黏膜反应的研究进展。     

Factors influencing comfort level in head and neck neoplasm patients receiving radiotherapy

ObjectiveTo determine factors that influence comfort in head and neck neoplasm patients receiving radiotherapy.MethodsIn total, 200 head and neck neoplasm patients receiving radiotherapy were recruited from three tertiary first class hospitals. They were assessed by Radiotherapy Comfort Questionnaire for patients with head and neck neoplasm, Social Support Scale, and Medical Coping Modes Questionnaire.ResultsThe total score of comfort was 60.54 ± 8.32. Multiple linear regression analysis indicated that number of radiation treatments, family accompaniment, educational level, resignation coping mode, complications due to diabetes, accompanying chemotherapy, and the utilization of social support significantly influenced comfort level (p < 0.05). Among these, number of radiation treatments, complications due to diabetes, accompanying chemotherapy, and resignation coping were negative factors.ConclusionEncouraging utilization of social support systems and a positive coping mode is important for increasing comfort level in head and neck neoplasm patients during radiotherapy. Nurses should pay particular attention to those patients during later stages of radiotherapy or chemotherapy, with diabetes, without family accompaniment, and with lower education level.     

头颈肿瘤手术缺损的修复方法

头颈部肿瘤切除后多数需要利用自体组织进行修复,在目前众多的修复手段当中如何选用合适的组织瓣,达到创面及时愈合,同时恢复外形和功能是耳鼻咽喉头颈外科医生共同关注的难题,本文就相关的问题进行阐述。     

Apoptotic and inflammation markers in oral mucositis in head and neck cancer patients receiving radiotherapy: preliminary report

GOAL OF WORK: The aim of this study was to investigate the expression of pro-apoptotic protein p53 and anti-apoptotic proteins BCl-2 and MCl-1, as well as the expression of pro-inflammatory cytokines tumor necrosis factor (TNF) and interleukin-1beta (IL-1beta) in patients developing mucositis during radiotherapy for head and neck cancer. MATERIALS AND METHODS: Thirty-five patients receiving radiotherapy for head/neck cancer were included in this study. Patients were examined before radiotherapy. Oral mucositis was recorded weekly during radiotherapy. Cytologic smears from the oral cavity were taken with a brush. Immunocytochemical staining was performed by the use of p53, BCl-2, MCl-1 TNF and IL-1beta monoclonal antibodies. MAIN RESULTS: P53 was expressed in 1 of 15 smears before the initiation of radiotherapy (6.5%) compared to 3 of 7 smears from patients with grade III mucositis (43%) during radiotherapy. BCl-2 was expressed in 15 of 15 smears before radiotherapy (100%) and in three of seven patients with grade III mucositis (43%) during radiotherapy. MCl-1 was expressed in 10 of 14 samples before radiotherapy (71.5%) and in two of seven patients with grade III (28.5%) mucositis during radiotherapy. TNF was expressed in 9 of 14 patients before radiotherapy (64%) and in six of seven patients with grade III mucositis during radiotherapy (86%). IL-1beta was detected in 7 of 14 patients before radiotherapy (50%) compared to 6 of 7 patients with grade III mucositis during radiotherapy (86%). CONCLUSION: Our preliminary results indicate an induction of apoptosis and inflammation in the oral mucosa in patients developing mucositis during radiotherapy for head/neck cancer.