刘亭 鞠进

摘要：目的  探讨氨磷汀联合精准护理治疗口腔癌放疗的效果。方法  选择2015年1月～2017年12月我院收治的口腔癌根治性放化疗患者104例，随机分为观察组（n=43）和对照组（n=52），两组患者均实施精准护理，观察组配合使用氨磷汀，对照组未使用。比较两组患者放射性口腔黏膜炎发生情况及氨磷汀的消化道反应情况。结果  观察组Ⅳ度放射性黏膜炎5例，愈合时间中位数为28 d，对照组Ⅳ度放射性黏膜炎12例，愈合时间中位数为35 d。观察组出现Ⅳ度黏膜炎比例更低，且愈合时间更快，差异均有统计学意义（P<0.05）;观察组Ⅰ度消化道反应19例（44.19%）、Ⅱ度消化道反应10例（23.26%），对照组Ⅰ度消化道反应20例（38.46%）、Ⅱ度消化道反应11例（21.15%），两组均无Ⅳ度消化道反应出现，观察组Ⅰ～Ⅱ度消化道反应发生率高于对照组，但差异无统计学意义（P>0.05）。结论  采用氨磷汀治疗口腔癌放疗患者的同时配合精准护理，降低了放射性口腔黏膜炎的发生率，缩短愈合时间，同时氨磷汀的消化道反应未影响患者的生活质量。

关键词：氨磷汀;放疗;口腔癌;精准护理

Abstract：Objective  To explore the effect of amifostine combined with precision nursing on oral cancer radiotherapy.Methods  A total of 104 patients with radical chemoradiotherapy for oral cancer admitted to our hospital from January 2015 to December 2017 were randomly divided into observation group （n=43） and control group （n=52）， both groups of patients were treated with precision care， and the observation group was combined with amifostine. The control group was not used. The incidence of radioactive oral mucositis and the digestive tract reaction of amifostine were compared between the two groups.Results 5 patients with grade IV radiation mucositis were observed in the observation group. The median healing time was 28 d. In the control group， 12 patients with grade IV radiation mucositis had a median healing time of 35 d. In the observation group， the proportion of IV degree mucositis was lower， and the healing time was faster， the difference was statistically significant （P<0.05）. In the observation group， 19 cases （44.19%） of grade I digestive tract reaction and 10 cases of grade II digestive tract reaction （23.26%）， In the control group， there were 20 cases of digestive tract reaction （38.46%） and 11 cases of grade II digestive tract reaction （21.15%）. There was no IV digestive tract reaction in both groups. The incidence of I-II degree digestive tract reaction in the observation group was higher than that in the control group， but the difference was not statistically significant （P>0.05）.Conclusion  The use of amifostine in the treatment of oral cancer patients with radiotherapy has reduced the incidence of radiation oral mucositis and shortened the healing time. At the same time， the digestive tract reaction of amifostine did not affect the quality of life of patients.

Key words：Amifostine;Radiotherapy;Oral cancer;Precise care

口腔癌（oral cancer）是頭颈部常见的恶性肿瘤之一，包括舌癌、颊黏膜癌、扁桃体癌以及口底癌等，部分患者由于分期晚，手术切除后修复困难，临床推荐以放疗为主的综合治疗[1]。放疗后患者的腮腺、唾液腺都受到一定程度的限制，使相应的腺体分泌减少，口腔的自净作用减弱，易引起口腔感染、溃疡和疼痛，甚至部分患者因无法耐受放疗副反应，中断放射治疗。因此如何减轻患者痛苦，保证患者坚持治疗，引起研究者重点关注。精准护理又叫个性化护理，这种护理模式是通过一系列标准化措施，通过衡量指标，结合患者疾病特征设计最佳护理方案，实现围绕安全、质量，以人为本、注重疗效的护理模式，是医疗改革和医院管理创新的一部分[2]。……