川云冰块预防鼻咽癌放射治疗口腔黏膜损伤临床观察
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摘要
目的目前临床上防治放射性口腔黏膜损伤方法效果不明显,多种不同方法用于临床以提高其疗效。本研究旨在探讨川贝枇杷膏和云南白药冰块(川云冰块)在鼻咽癌放射治疗后防治口腔黏膜损伤的疗效及安全性。方法选取2016-01-20-2018-04-12山东大学附属省立医院接受鼻咽癌放射治疗的100例患者为研究对象,分为观察组和常规组,各50例。常规组给予放射治疗的常规护理,观察组在此基础上给予川贝枇杷膏和云南白药冰块含服。回顾分析2组患者放射治疗后口腔黏膜放射性炎症程度、黏膜疼痛程度、口腔咽拭子培养有细菌率及体质量降低率情况。结果放射治疗第4周,2组患者口腔咽拭子培养有细菌率(χ~2=0.542,P=0.461)和体质量降低率(χ~2=1.000,P=0.317)比较,差异均无统计学意义。放射治疗第8周,观察组及常规组Ⅲ、Ⅳ级口腔黏膜炎发生率分别为6%(3/50)、0(0/50)和32%(16/50)、18%(9/50),Z=-5.123,P<0.001;观察组及常规组口腔黏膜Ⅱ、Ⅲ度疼痛发生率分别为50%(25/50)、6%(3/50)和60%(30/50)、22%(11/50),Z=-3.078,P=0.002;观察组及常规组口腔咽拭子培养有细菌率分别为32%(16/50)和64%(32/50),χ~2=10.256,P=0.001;观察组及常规组体质量降低率分别为34%(17/50)和70%(35/50),χ~2=12.981,P=0.001,差异均有统计学意义。结论川云冰块能缓解鼻咽癌患者的放射性口腔黏膜炎症反应,减轻放射性黏膜疼痛,减少口腔细菌感染,从而改善营养状态。
OBJECTIVE Currently,the effect on prevention and treatment of oral mucosal damage after radiotherapy in nasopharyngeal carcinoma(NPC)remains poor.Different methods have been applied to increase the efficacy.This study reported the use of Nin Jiom Pei Pa Koa and Yun Nan Bai Yao Ice(for short Chuan Yun Ice,same as below)in the prevention and treatment of oral mucosal damage after NPC radiotherapy,and evaluated the efficacy and safety of using Chuan Yun Ice in prevention and treatment of patients with oral mucosal damage.METHODS Totally 100 patients with oral mucosal damage after NPC radiotherapy in Department of Oncology of Shandong Provincial Hospital Affiliated to Shandong University were selected from 2016-01-20 to 2018-04-12,and were randomly divided into the experimental group(50 cases)and the control group(50 cases).The patients in control group were given routine care of radiotherapy.The experimental group was Chuan Yun Ice in a convenient sublingual form.The degree of oral mucositis after NPC radiotherapy,mucosal pain,the bacterial rate in oral swab cultivation and body mass index loss rate were reviewed and analyzed between two groups.RESULTS After 4 weeks of radiotherapy,there were no significant differences of the bacterial rate in oral swab cultivation(χ~2=0.542,P=0.461)and body mass index loss rate(χ~2=1.000,P=0.317)between the two groups.After 8 weeks of radiotherapy,the degree of oral mucositis at stageⅢandⅣwere 6%(3/50),0 in control group and 32%(16/50),18%(9/50)in experimental group(Z=-5.123,P<0.001).The patients who were observedⅡ-grade pain andⅢ-grade pain were 50%(25/50),6%(3/50)in treatment group and 60%(30/50),22%(11/50)in control group(Z=-3.078,P=0.002).The bacterial rates in coral swab cultivation were 32%(16/50)and 64%(32/50)respectively(χ~2=10.256,P=0.001);body mass index loss rate in the two groups were 34%(17/50)and 70%(35/50),respectively(χ~2=12.981,P=0.001),and there was significantly difference between the two groups(P<0.05).CONCLUSION Chuan Yun Ice can relieve the radiation-induced inflammation of oral mucosal in patients with NPC,reduce the radioactive mucosal pain,decrease the oral bacteria infections and improve their nutritional status.
OBJECTIVE Currently,the effect on prevention and treatment of oral mucosal damage after radiotherapy in nasopharyngeal carcinoma(NPC)remains poor.Different methods have been applied to increase the efficacy.This study reported the use of Nin Jiom Pei Pa Koa and Yun Nan Bai Yao Ice(for short Chuan Yun Ice,same as below)in the prevention and treatment of oral mucosal damage after NPC radiotherapy,and evaluated the efficacy and safety of using Chuan Yun Ice in prevention and treatment of patients with oral mucosal damage.METHODS Totally 100 patients with oral mucosal damage after NPC radiotherapy in Department of Oncology of Shandong Provincial Hospital Affiliated to Shandong University were selected from 2016-01-20 to 2018-04-12,and were randomly divided into the experimental group(50 cases)and the control group(50 cases).The patients in control group were given routine care of radiotherapy.The experimental group was Chuan Yun Ice in a convenient sublingual form.The degree of oral mucositis after NPC radiotherapy,mucosal pain,the bacterial rate in oral swab cultivation and body mass index loss rate were reviewed and analyzed between two groups.RESULTS After 4 weeks of radiotherapy,there were no significant differences of the bacterial rate in oral swab cultivation(χ~2=0.542,P=0.461)and body mass index loss rate(χ~2=1.000,P=0.317)between the two groups.After 8 weeks of radiotherapy,the degree of oral mucositis at stageⅢandⅣwere 6%(3/50),0 in control group and 32%(16/50),18%(9/50)in experimental group(Z=-5.123,P<0.001).The patients who were observedⅡ-grade pain andⅢ-grade pain were 50%(25/50),6%(3/50)in treatment group and 60%(30/50),22%(11/50)in control group(Z=-3.078,P=0.002).The bacterial rates in coral swab cultivation were 32%(16/50)and 64%(32/50)respectively(χ~2=10.256,P=0.001);body mass index loss rate in the two groups were 34%(17/50)and 70%(35/50),respectively(χ~2=12.981,P=0.001),and there was significantly difference between the two groups(P<0.05).CONCLUSION Chuan Yun Ice can relieve the radiation-induced inflammation of oral mucosal in patients with NPC,reduce the radioactive mucosal pain,decrease the oral bacteria infections and improve their nutritional status.
引文
[1]满宪凤,范廷勇,邢军,等.鼻咽癌同步推量调强放疗与传统调强放疗的近远期疗效比较[J].中华肿瘤防治杂志,2016,23(4):244-247.
[2]Mallick S,Benson R,Rath GK.Radiation induced oral mucositis:a review of current literature on prevention andmanagement[J].Eur Arch Otorhinolaryngol,2016,273(9):2285-2293.
[3]Shin YS,Shin HA,Kang SU,et al.Effect of epicatechin against radiation-induced oral mucositis:in vitro and in vivo study[J/CD].PLoS One,2013,8(7):e69151.
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[5]周文莉,阚文彬,王玉红,等.微流蒸发光散射检测器与加压毛细管电色谱联用测定川贝枇杷糖浆中6种有效成分的含量[J].分析测试学报,2015,34(3):321-327.
[6]缪雪阳,夏同霞,缪炜烈,等.苦参膜与rhEGF凝胶分别联合云南白药用于宫颈LEEP术后创面的临床观察[J].中国药房,2017,28(6):752-755.
[7]刘跃,李懿,王永刚,等.比亚芬联合云南白药及康复新混合液保留灌肠治疗放射性直肠炎[J].西南国防医药,2015,25(7):748-750.
[8]徐建婷,张坤强,苏冰莲.自制含漱液防治鼻咽癌口腔放疗反应效果观察[J].护理学杂志,2005,20(11):29-30.
[9]Williamson A,Hoqqart B.Pain:a review of three commonly used pain rating scales[J].J Clin Nurs,2005,14(7):798-804.
[10]左艳辉.子宫内膜癌术后醋酸甲地孕酮辅助化疗对改善患者食欲和体质量的效果观察[J].临床合理用药,2017,10(12):89-90.
[11]徐洁,李袆萍,钱荣誉.调强放疗对中晚期鼻咽癌放射性脑损伤的相关影响[J].中华肿瘤防治杂志,2016,23(S2):65-66.
[12]Lorenzoni DC,Fracalossi AC,Carlin V,et al.Mutagenicity and Cytotoxicity in patients submitted to ionizing radiation[J].Angle Orthod,2013,83(1):104-109.
[13]Ahmadi A.Potential prevention:Aloe Vera mouthwash may reduce radiation-induced oral mucositis in head and neck cancer patients[J].Chin J Inteqr Med,2012,18(8):635-640.
[14]张丽娟.鼻咽癌放疗后鼻窦炎的临床治疗观察[J].中华肿瘤防治杂志,2016,23(1):58-59.
[15]黄露,梁键,林海珍,等.复方紫草地榆油对鼻咽癌患者放射性口腔黏膜炎的疗效观察[J].中国中医药科技,2015,22(2):198-199.
[16]赵静,马春玲,支政.补益气阴通络生津法防治急性放射性口咽黏膜反应的临床观察[J].时珍国医国药,2016,27(6):1414-1416.
[17]周华俊.念慈庵川贝枇杷膏免疫功能的研究[J].中国现代药物应用,2011,5(16):3-4.
[18]聂木海,诸茂盛,麦惠霞,等.川贝枇杷膏对大鼠亚慢性毒性及SOD酶活性实验研究[J].中国卫生检验杂志,2002,12(5):546-547.
[19]De FC,Salum FG,Cherubini K,et al.Antioxidant agents:a future alternative approach in the prevention and treatment of radiation-induced oral mucositis?[J].Altern Ther Health Med,2015,21(2):36-41.
[20]江波,孙勤国,祁青.口疡清方治疗复发性口腔溃疡疼痛的临床观察[J].中国中医基础医学杂志,2015,21(11):1431-1432.
[21]赵文珍,刁娜,谷艺修,等.云南白药辅助治疗溃疡性结肠炎的开放随机对照研究[J].南方医科学大学报,2016,36(9):1186-1191.
[2]Mallick S,Benson R,Rath GK.Radiation induced oral mucositis:a review of current literature on prevention andmanagement[J].Eur Arch Otorhinolaryngol,2016,273(9):2285-2293.
[3]Shin YS,Shin HA,Kang SU,et al.Effect of epicatechin against radiation-induced oral mucositis:in vitro and in vivo study[J/CD].PLoS One,2013,8(7):e69151.
[4]Peterson DE,Boers-Doets CB,Bensadoun RJ,et al.Management of oral and gastrointestinal mucosal injury:ESMO clinical practice guidelines for diagnosis,treatment,and follow-up[J].Ann Oncol,2015,26(Suppl 5):139-151.
[5]周文莉,阚文彬,王玉红,等.微流蒸发光散射检测器与加压毛细管电色谱联用测定川贝枇杷糖浆中6种有效成分的含量[J].分析测试学报,2015,34(3):321-327.
[6]缪雪阳,夏同霞,缪炜烈,等.苦参膜与rhEGF凝胶分别联合云南白药用于宫颈LEEP术后创面的临床观察[J].中国药房,2017,28(6):752-755.
[7]刘跃,李懿,王永刚,等.比亚芬联合云南白药及康复新混合液保留灌肠治疗放射性直肠炎[J].西南国防医药,2015,25(7):748-750.
[8]徐建婷,张坤强,苏冰莲.自制含漱液防治鼻咽癌口腔放疗反应效果观察[J].护理学杂志,2005,20(11):29-30.
[9]Williamson A,Hoqqart B.Pain:a review of three commonly used pain rating scales[J].J Clin Nurs,2005,14(7):798-804.
[10]左艳辉.子宫内膜癌术后醋酸甲地孕酮辅助化疗对改善患者食欲和体质量的效果观察[J].临床合理用药,2017,10(12):89-90.
[11]徐洁,李袆萍,钱荣誉.调强放疗对中晚期鼻咽癌放射性脑损伤的相关影响[J].中华肿瘤防治杂志,2016,23(S2):65-66.
[12]Lorenzoni DC,Fracalossi AC,Carlin V,et al.Mutagenicity and Cytotoxicity in patients submitted to ionizing radiation[J].Angle Orthod,2013,83(1):104-109.
[13]Ahmadi A.Potential prevention:Aloe Vera mouthwash may reduce radiation-induced oral mucositis in head and neck cancer patients[J].Chin J Inteqr Med,2012,18(8):635-640.
[14]张丽娟.鼻咽癌放疗后鼻窦炎的临床治疗观察[J].中华肿瘤防治杂志,2016,23(1):58-59.
[15]黄露,梁键,林海珍,等.复方紫草地榆油对鼻咽癌患者放射性口腔黏膜炎的疗效观察[J].中国中医药科技,2015,22(2):198-199.
[16]赵静,马春玲,支政.补益气阴通络生津法防治急性放射性口咽黏膜反应的临床观察[J].时珍国医国药,2016,27(6):1414-1416.
[17]周华俊.念慈庵川贝枇杷膏免疫功能的研究[J].中国现代药物应用,2011,5(16):3-4.
[18]聂木海,诸茂盛,麦惠霞,等.川贝枇杷膏对大鼠亚慢性毒性及SOD酶活性实验研究[J].中国卫生检验杂志,2002,12(5):546-547.
[19]De FC,Salum FG,Cherubini K,et al.Antioxidant agents:a future alternative approach in the prevention and treatment of radiation-induced oral mucositis?[J].Altern Ther Health Med,2015,21(2):36-41.
[20]江波,孙勤国,祁青.口疡清方治疗复发性口腔溃疡疼痛的临床观察[J].中国中医基础医学杂志,2015,21(11):1431-1432.
[21]赵文珍,刁娜,谷艺修,等.云南白药辅助治疗溃疡性结肠炎的开放随机对照研究[J].南方医科学大学报,2016,36(9):1186-1191.
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