头颈部肿瘤放疗后口腔干燥治疗研究进展

目的 综合目前头颈部肿瘤放疗后口腔干燥治疗研究现状，分析目前口腔干燥治疗方法的优缺点以及将来研究方向。方法 查询多种相关治疗资料，根据唾液分泌生理学机制和目前放射性损伤机理，分析各种治疗可能存在的缺陷，引发相关医务人员在治疗方面更好开发新的治疗方法。结果 唾液的生理性分泌是完全神经反射性的，头颈部肿瘤放疗后口腔干燥涉及感受器、传入神经、传出神经、效应器损伤，目前主要针对效应器的治疗，反射弧其余部位的损伤靠自行修复，难以短时间达到应有的疗效。结论 减少射野内反射弧照射剂量是有效的预防措施，已形成的口腔干燥需要针对反射弧多环节综合治疗。     

头颈部肿瘤涎腺放射性损伤的防治研究进展

放射性涎腺损伤是头颈部肿瘤患者放射治疗后最常见的并发症之一,表现为口腔疼痛,说话、吞咽困难等症状,严重影响患者的生存质量。因此,涎腺放射性损伤的防治十分重要。本文从放疗保护药物、放疗技术、分子生物学等方面,针对头颈部肿瘤涎腺放射性损伤的预防与治疗予以综述。     

Modified schirmer test–A screening tool for xerostomia among subjects on antidepressants

ObjectiveThe aim of the present study is to assess salivary flow rate in the subjects who were on antidepressant medications and its comparison with healthy controls and assessment of unstimulated salivary flow rate by modified Schirmer test (MST) and volumetric method (spitting method) for evaluation of xerostomia and whether any correlation exists between two methods.Material and MethodsThirty subjects who were on antidepressants were divided into two groups: tricyclic antidepressants (TCA) and selective sertonin reuptake inhibitors (SSRI) of 15 each, compared with 30 age and gender matched controls. Unstimulated salivary flow rate was measured by both MST and spitting method.ResultsThe unstimulated salivary flow rate measured by MST at the end of 3rd minute was 13.7 ± 10.08, 19.86 ± 8.95 and 31.0 ± 5.4 mm and by spitting method was 0.12 ± 0.07, 0.19 ± 0.10 and 0.30 ± 0.75 ml/min in TCA, SSRI and controls respectively (p < 0.001). The Pearson correlation coefficient of r = 0.85 shows excellent correlation between the two screening tests. Sensitivity and Specificity of MST was 90.9% and 31.5%.ConclusionSalivary flow rate was less in antidepressant subjects when compared to the healthy controls. Results of the present study showed an excellent correlation excellent correlation between the two screening tests which suggests that MST can be routinely used as chair-side screening tool to evaluate hyposalivation which is time saving, patient friendly and specific of salivary secretions.     

腮腺显像对鼻咽癌放疗后腮腺功能的评价

目的利用腮腺显像研究鼻咽癌放疗后腮腺的摄取与排泄功能.方法48例鼻咽癌患者中,对38例肿瘤和肿大淋巴结行加速调强放疗（SMART）,其亚临床灶和预防照射区接受常规照射;余10例行常规放疗.放疗前后均行腮腺显像,计算腮腺的放射性摄取指数（UI）及酸性刺激后排泌指数（EI）,对腮腺功能损伤情况进行分析;同时记录患者口干程度并分级.结果鼻咽癌SMART组放疗后腮腺UI和EI分别下降21.9%和37.3%,中重度口干者12例;而常规放疗组腮腺功能明显下降,UI和EI分别下降56.1%和96.1%,中重度口干者9例,两者比较差异均有显著性（P＜0.05）.结论腮腺显像可灵敏地监测鼻咽癌放疗后腮腺功能.     

Symptom control

Symptom control has become increasingly recognized as an important goal in patient care. In this article, advances in symptom assessment, and various definitions of symptom improvement are reviewed. Theoretical concepts underlying symptom control and clinically significant change are presented, as well as the role of symptom control as an endpoint in clinical trials. Symptom control is then surveyed in two broad categories for selected symptoms. The first area is therapy related symptoms, secondary to chemotherapy, radiation, hormonal therapy, and surgery. Symptoms reviewed include chemotherapy related mucositis, emesis, fatigue; hot flashes; and radiation related dermatitis, xerostomia, and mucositis. The second area is palliative oncologic approaches to disease-related symptoms. Results in palliative chemotherapy, palliative radiation therapy, cancer pain, and lack of appetite are summarized. Areas requiring further research are noted. Findings are presented in both a clinical and research context to help guide the reader with interpreting symptom control studies.     

口干症204例临床分析

目的 总结口干症的临床特点。方法 对204例口干症患者进行唾液白色念珠菌培养、泪腺流量测试、血细胞计数。结果 40岁以上年龄组发病率无明显区别,男女比例为1:5.57,口腔白色念珠菌感染75例,双侧泪腺流量异常16例,1侧异常28例,贫血32例。结论 贫血症、白色念珠菌感染与口干症有密切关系,更年期女性发病率最高。     

辨证分型治疗维持性血液透析口干症临床观察

[目的]观察辨证分型治疗维持性血液透析口干症疗效。[方法]对51例维持性血液透析住院患者辨证分型,脾肾气虚一补益脾肾,益气生津（党参、黄芪各20g,白术15g,山药30g,茯苓15g,升麻、柴胡各6g,葛根20g）;阴阳两虚-补益脾肾,养阴温阳（制附片6g,女贞子、旱莲草、仙茅根、仙灵脾各15g,山药30g,茯苓15g）;肝肾阴虚一滋补肾阴（生地、山药各30g,山茱萸15g,丹皮10g,茯苓15g,泽泻10g）;气阴两虚-益气养阴（太子参20g,麦冬15g,五味子6g,黄芪、山药各30g,茯苓20g,鲜石斛12g,葛根15g）;脾肾阳虚．温补肾阳（制附片10g,肉桂3g,生地15g,山药30g,山茱萸15g,丹皮10g,茯苓15g,泽泻10g）;脾肾阳虚-温补肾阳（制附片10g,肉桂3g,生15g,山药30g,山莱萸15g,丹皮10g,茯苓15g,泽泻10g）。1剂／d,浓煎100mL,早晚温服。夹湿浊加苍术15g,厚朴10g;夹湿热加黄柏、知母各10g;夹热毒加黄连10g,制大黄30g;夹瘀血加丹参30g,红花10g。连续治疗7d为1疗程。观测临床症状、不良反应。治疗1疗程（7d）,判定疗效。[结果始愈25例,显效16例,好转7例,无效3例,总有效率94．12％。[结论]辨证分型治疗维持性血液透析口干症,提高生存质量、防治并发症有积极意义。     

毛果芸香碱治疗原发性干燥综合征44例疗效观察

目的观察毛果芸香碱治疗原发性干燥综合征所致口干的疗效和不良反应。方法44名原发性干燥综合征患者参加本随机双盲对照试验。患者随机接受4mg毛果芸香碱或16mg必嗽平片剂。每天4次,共28d。通过对主观口干症状评价和唾液量分泌量测定方式进行全面评估。结果与对照组相比,毛果芸香碱组口干不适症状获得显著改善、唾液分泌量明显增加。结论表明毛果芸香碱治疗干燥综合征口干有效、安全,而且耐受性良好。