放化疗所致口腔黏膜炎危险因素分析和护理干预

目的：探讨放化疗所致口腔黏膜炎的危险因素,为预防和降低口腔黏膜炎的发生提供科学依据。方法：对99例放化疗患者口腔状态进行横断面调查分析,以其中34例口腔黏膜炎患者为研究组,65例非口腔黏膜炎患者为对照组,比较两组患者在年龄、肿瘤部位、化疗方案、口腔评估得分等12个方面的差异,首先对这两组资料进行单因素χ2检验,然后选择差异有统计学意义的影响因素进行Logistic多因素回归分析。结果：放化疗所致口腔黏膜炎的发生率为34.3%。发生部位的构成比中,颊部为27.4%,牙龈为16.1%,硬腭为3.2%。口腔黏膜炎发生分度构成比中Ⅰ度口腔黏膜炎为47.1%,Ⅳ度为8.8%。多因素分析最终进入回归方程的影响因素有：恶心呕吐、住院天数、含5-氟尿嘧啶化疗、肿瘤部位、白细胞下降程度和口腔评估得分。结论：放化疗所致口腔黏膜炎的发生率为34.4%,多发于颊、牙龈等非角化上皮组织,以Ⅰ度口腔黏膜炎的发病率最高。与口腔黏膜炎发生有关的危险因素是：恶心呕吐、住院天数长、化疗方案中含5-氟尿嘧啶、头颈部位肿瘤、白细胞下降严重及口腔评估得分高。为了减少口腔黏膜炎的发生,除了做好常规基础护理外,还要加强对护理人员的教育,重视口腔评估,并根据引起口腔黏膜炎的各种危险因素,采取针对性的护理干预。

Risk Factors and Nursing Intervention in Radiotherapy and Chemotherapy-induced Oral Mucositis

Objective: To find out what the risk factors are in radiotherapy and chemotherapy induced oral mucositis,then scientific evidences can be provide to prevent and reduce the incidence of oral mucositis.Methods:A cross-sections survey was done among 99 cases who were accepting chemotherapy and radiotherapy, all the medical records of the research were reviewed.34 cases with oral mucositis were put in the study group,65 cases with non-oral mucositis were put in control group.The differences of age,tumor location,oral assessment score,and other nine risk factors between the two groups were compared.The data were analyzed with single factor χ2 test and Logistic regression analysis.Results:The incidence of oral mucositis was 34.3%.The respectively incidences of cheek and gum injury were 27.4% and 16.1%.But the incidence of hard palate was 3.2%.The respectively incidences of Ⅰand Ⅳ degree oral mucositis were 47.7% and 8.8%.After multivariate analysis,nausea and vomiting,hospitalization days, 5-fluorouracil chemotherapy,tumor location, decrease extent of white cell and oral assessment scores eventually entered the regression equation.Conclusion:The incidence of chemotherapy-induced oral mucositis is 34.4%,cheek and gums,and other non-keratinized epithelial tissues were more vulnerable to oral mucositis.The risk factors of oral mucositis are: nausea,vomiting,many days stay in hospital,chemotherapy regimens containing 5-fluorouracil,head and neck tumor, serious decline of white cells and oral assessment scores high.In order to reduce the incidence of oral mucositis,except conventional basic nursing,we also should strengthen the nursing education,pay more attention to oral assessment,and targeted nursing intervention can be provide in accordance with the various risk factors of oral mucositis