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鼻咽癌是一种多发性恶性肿瘤,放射性治疗(放疗)是其主要的治疗手段[1]。但治疗过程中有90%~95%的病人会出现不同程度的颈部皮肤损伤,表现为疼痛、干性脱皮、溃疡及坏死等严重反应,甚至出现湿性脱皮症状,给病人带来极大的痛苦,同时还可引起病人焦虑、抑郁等情绪,影响生存质量[2]。这是由于放疗引起凋亡诱导基因与凋亡抑制基因失调,皮肤组织细胞过度凋亡[3],引起皮肤干燥、萎缩和纤维化进而导致皮肤损伤,尤其在颈部皮肤较薄、褶皱和易于摩擦处皮肤更易发生。目前,临床针对防治鼻咽癌病人放疗所致的颈部皮肤损伤还缺乏有效的措施,当下研究重点主要是促进创伤面快速愈合。临床实践表明,局部直接给药、敷料和心理、皮肤护理是当前防治放疗所致皮肤损伤的主要方法,其中,局部皮肤敷料不同,其防治效果也不同。本研究选用新型软聚硅酮泡沫敷料美皮康和康复新液,比较二者对于鼻咽癌放疗所致的颈部皮肤损伤的防护作用及对病人情绪的影响,以期为临床护理提供参考。现作报道。
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2组病人皮肤损伤程度分级差异有统计学意义,观察组优于对照组(P < 0.05)(见表 1)。
分组 n 0级 1级 2级 3级 uc P 对照组 27 1(3.70) 10(37.04) 11(40.74) 5(18.52) 观察组 27 2(7.40) 18(66.67) 5(18.52) 2(7.40) 2.35 <0.05 合计 54 3(5.56) 18(33.33) 16(29.63) 7(12.92) 表 1 2组病人照射野皮肤损伤程度分级比较[n; 百分率(%)]
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观察组照射野皮肤创面愈合时间明显少于对照组(P < 0.01),愈合创面比例亦明显高于对照组(P < 0.01)(见表 2)。
分组 n 皮肤创面愈合时间/d 愈合创面比例/% 对照组 27 12.61±1.49 49.62±2.06 观察组 27 5.79±0.92 69.28±1.28 t — 19.31* 38.76* P — <0.01 <0.01 表 2 2组病人创面愈合时间和愈合创面比例比较(x±s)
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干预前,2组病人SAS、SDS评分差异均无统计学意义(P>0.05);干预后,2组SAS、SDS评分均较干预前降低(P < 0.05),且观察组SAS、SDS评分均低于对照组(P < 0.05)(见表 3)。
分组 n SAS评分 SDS评分 干预前 对照组 27 63.20±4.18 64.90±4.89 观察组 27 63.78±5.61 65.02±4.95 t — 0.60 0.12 P — >0.05 >0.05 干预后 对照组 27 52.98±10.72* 54.76±11.67* 观察组 27 46.64±6.35* 42.71±6.61* t — 2.65 3.51 P — < 0.05 < 0.05 组内配对t检验:*P < 0.05 表 3 2组病人干预前后SAS、SDS评分比较(x±s; 分)
不同护理干预对鼻咽喉癌病人颈部皮肤损伤及情绪的影响
Effect of different nursing interventions on neck skin damage and emotion of patients with nasopharyngeal carcinoma
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摘要:
目的探讨新型软聚硅酮泡沫敷料美皮康和康复新液对接受放射治疗鼻咽喉癌病人颈部皮肤损伤的防护作用及其对病人情绪的影响。 方法选取接受放射治疗鼻咽癌病人54例为研究对象,采用随机数字表法将病人分为对照组(康复新液组)和观察组(美皮康组),各27例,于放射治疗2 d前给予对照组康复新液、观察组美皮康护理干预,比较2组病人颈部皮肤损伤程度、创面愈合时间、愈合创面比例和干预前后的SDS评分、SAS评分。 结果2组病人颈部皮肤损伤情况差异有统计学意义(P < 0.05);观察组颈部皮肤创面愈合时间明显少于对照组(P < 0.01),愈合创面比例明显高于对照组(P < 0.01)。干预前,2组病人SAS、SDS评分差异均无统计学意义;干预后,2组SAS、SDS评分均较干预前降低(P < 0.05),且观察组SAS、SDS评分均低于对照组(P < 0.05)。 结论新型软聚硅酮泡沫敷料美皮康能明显减轻鼻咽喉癌放射治疗所致的颈部皮肤损伤程度、缩短创面愈合时间,同时可缓解病人的焦虑、抑郁情绪,值得临床推广使用。 Abstract:ObjectiveTo investigate the protective effects of new soft silicone foam dressing Mepilex Lite and Kangfuxin solution on neck skin injury and its effects on emotion in nasopharyngeal carcinoma(NPC) patients treated with radiotherapy. MethodsFifty-four NPC patients treated with radiotherapy were randomly divided into the control group(Mepilex group) and observation group(Kangfuxin group) (27 cases in each group).The control group and observation group were nursed with Kangfuxin solution and Mepilex Lite after 2 d of radiotherapy.The degree of neck skin injury, wound healing time, wound healing proportion, SDS score and SAS score before and after intervention were compared between two groups. ResultsThere was statistical significance in the skin injury between two groups(P < 0.05).The healing time and rate of skin wound in observation group were significantly less and higher than those in control group, respectively(P < 0.01).Before intervention, the differences of the scores of SAS and SDS between two groups were not statistically significant(P>0.05).After intervention, the scores of SAS and SDS in two groups decreased compared with before inervention(P < 0.05), and the scores of SAS and SDS in observation group were lower than those in control group(P < 0.05). ConclusionsThe application of Mepilex Lite can significantly reduce the degree of neck skin injury caused by radiotherapy for nasopharyngeal carcinoma, shorten the healing time of wound surface, and relieve the anxiety and depression of patients, which is worthy of clinical promotion. -
Key words:
- nurse /
- nasopharyngeal neoplasms /
- radiotherapy /
- skin damage /
- soft silicone foam dressing /
- Mepilex Lite /
- Kangfuxin solution
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表 1 2组病人照射野皮肤损伤程度分级比较[n; 百分率(%)]
分组 n 0级 1级 2级 3级 uc P 对照组 27 1(3.70) 10(37.04) 11(40.74) 5(18.52) 观察组 27 2(7.40) 18(66.67) 5(18.52) 2(7.40) 2.35 <0.05 合计 54 3(5.56) 18(33.33) 16(29.63) 7(12.92) 表 2 2组病人创面愈合时间和愈合创面比例比较(x±s)
分组 n 皮肤创面愈合时间/d 愈合创面比例/% 对照组 27 12.61±1.49 49.62±2.06 观察组 27 5.79±0.92 69.28±1.28 t — 19.31* 38.76* P — <0.01 <0.01 表 3 2组病人干预前后SAS、SDS评分比较(x±s; 分)
分组 n SAS评分 SDS评分 干预前 对照组 27 63.20±4.18 64.90±4.89 观察组 27 63.78±5.61 65.02±4.95 t — 0.60 0.12 P — >0.05 >0.05 干预后 对照组 27 52.98±10.72* 54.76±11.67* 观察组 27 46.64±6.35* 42.71±6.61* t — 2.65 3.51 P — < 0.05 < 0.05 组内配对t检验:*P < 0.05 -
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