【作者】 陆茵；

【导师】 徐桂华；

【作者基本信息】 南京中医药大学 ， 护理学， 2012， 硕士

【摘要】 [目的]探讨口腔冷疗对预防接受清髓性预处理方案的造血干细胞移植病人并发口腔黏膜炎的效果。探讨不同口腔冷疗干预时机及冷疗时间对预防口腔黏膜炎的效果。探索适合清髓性造血干细胞移植病人的口腔护理路径。[方法]本研究为随机临床试验。以苏州大学附属第一医院血液科移植病房37位进行清髓性造血干细胞移植,自愿参与本研究并符合纳入标准的病人为研究对象。在进行干细胞移植病人常规口腔护理的基础上,根据预处理期间是否使用口腔含冰法将研究对象分为实验组和对照组(共12例)。同时按照药代动力学及药物清除时间,确定口腔冷疗干预时机,并将实验组分为实验组(1)(造血干细胞移植预处理期间,实施口腔冷疗干预是从药物输注时开始持续至该药物使用结束,共12例)和实验组(2)(口腔冷疗从药物输注1/2时开始持续至该药物输注结束,共13例)。所得数据用统计软件15.0进行分析。[结果]①根据美国国家癌症研究机构常用化疗药物毒性标准(NCI一CTC)及WHO黏膜炎评分标准,三组口腔黏膜炎发生率分别为：实验组(1)49.67%、实验组(2)47.69%、对照组54.33%,三组病人口腔粘膜炎发生情况无统计学差异(X2=4.989,P=0.083)②短时冷疗(即实验组(2))有效控制清髓性预处理方案所致的3级以上口腔黏膜炎发生,与对照组相比有明显差异(X2=5.675,P=0.017<0.05)③实验组(2)可明显缩短口腔黏膜炎平均持续时间,三组比较有显著统计学差异(X2=8.075,P=0.018<0.05)。④口腔黏膜炎易发生在颊部(43.9%)、舌部(27.57%)等非角膜部位。⑤口腔冷疗并不能很好改善移植病人口腔舒适度,结果显示：预处理期间,随着用药时间延长,长时间冷疗比短时冷疗移植病人自身不适症状描述更严重。⑥短时冷疗(实验组(2))可改善移植期间病人胃肠不适症状,尤其可改善移植病人预处理期间恶心症状,减少呕吐次数。[结论]①口腔冷疗可降低造血干细胞移植患者预处理所致口腔黏膜炎的发生率。②对进行清髓性造血干细胞移植的病人,预处理期间可采用口腔冷疗干预措施,但应根据使用药物的不同,关注进行口腔冷疗的时间及干预时机。更多还原

【Abstract】 [Object] The purpose of this study is to investigate the effect of oral cryotherapy in prevention of oral mucositis in patients receiving myeloablative hematopoietic stem cell transplation, to explore the effect of different time of using method of oral cryotheapy and different oral cryotheapy duration., as well as to find a path of clinical oral nursing for the patient of HSCT.[Method] This study is a prospective random clinical study, which involves voluntary37patients, who come from the bone marrow transplantation unit of the First Affliated Hospital of Suzhou University. With the basic oral nursing, the objects of the study are divided into study group and control group depending on whether using the method of oral cryotheapy or not. Meanwhile, decide on the best opportunity of oral cryotheapy intervention according to pharmacokinetics and phase of drug elimination. Study group are divided into no.1(Using oral cryotheapy from the very beginning of drug infusion) and no.2(Using oral cryotheapy half way of drug infusion). Then analyze and compare the data by spss15.0.[Result]①According to the National Cancer Institute-Common Toxicity Criteria and WHO Mucositis Grading, the rate of mucositis is49.67%in study group one,47.69%in study group two, and54.33%in control group, the results of the three group are not statistically different(P<0.05).②Shorten duration of oral cryotherapy has a good effect on preventing severe oral mucositis caused by myeloablative therapy.③There are statistically significant differences in terms of group in the fact of media lasting time of oral mucositis(X2=8.075,P=0.018<0.05).④Oral mucositis can easily occur at cheek(43.9%)、tongue(27.57%)etc.⑤Oral cryotheapy can’t improve the oral comfort level of the renal transplant patients very well. During the period of myeloablative therapy, as the drug using time extends, the uncomfortable feeling of the HSCT patients is more severe in study group one.⑥Shorten duration of oral cryotherapy can especially improve patients’uncomfortable symptoms in stomach and intestine while they are in the period of myeloablative therapy, such as reducing the frequency of nausea and vomit.[conclusion]①Our findings have demonstrated that oral cryotherapy can reduce oral mucositis which caused by the myeloablative therapy.②To the HSCT patients, while using oral cryotheapy, we should pay great attention to the time and duration.更多还原