宫颈癌放射性皮肤损伤的标准化护理
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摘要
目的减轻宫颈癌同期放化疗患者放射性皮肤损伤程度。方法将434例宫颈癌同期放化疗患者随机分为观察组与对照组各217例。两组均接受放疗联合同期化疗,对照组按常规进行放射性皮肤损伤防护;观察组根据患者放疗剂量及患者局部情况设计标准化防护方案、规范评估方法、统一防护操作技术防护流程,进行严格质量控制。结果观察组放射性皮肤损伤严重程度显著轻于对照组,会阴部卫生清洁合格率及内裤穿着合格率显著高于对照组(均P<0.01)。结论标准化防护方案的实施可有效减轻宫颈癌同期放化疗患者放射性皮肤损伤程度,提高患者卫生防护行为。
Objective To reduce the severity of radiation-induced skin injury in cervical cancer patients receiving concurrent radiochemotherapy.Methods A total of 434 cervical cancer patients receiving concurrent radiochemotherapy were randomized into a control group and an observation group,with 217 cases in each group.The control group was subjected to routine preventive care of radiation-induced skin injury,while the observation group was given standardized preventive care including formulating care plan according to radiation dose and local skin conditions of the patient,standardizing assessment methods,unifying preventive procedural techniques and process,and conducting quality control.Results The observation group had milder radiation-induced skin injury and higher qualified rates of perineal hygiene and underwear wearing compared with the control group(P<0.01 for all).Conclusion The implementation of standardized preventive care effectively ameliorates skin damage during radiotherapy in cervical cancer patients receiving concurrent radiochemotherapy,and improves healthy behavior of patients.
Objective To reduce the severity of radiation-induced skin injury in cervical cancer patients receiving concurrent radiochemotherapy.Methods A total of 434 cervical cancer patients receiving concurrent radiochemotherapy were randomized into a control group and an observation group,with 217 cases in each group.The control group was subjected to routine preventive care of radiation-induced skin injury,while the observation group was given standardized preventive care including formulating care plan according to radiation dose and local skin conditions of the patient,standardizing assessment methods,unifying preventive procedural techniques and process,and conducting quality control.Results The observation group had milder radiation-induced skin injury and higher qualified rates of perineal hygiene and underwear wearing compared with the control group(P<0.01 for all).Conclusion The implementation of standardized preventive care effectively ameliorates skin damage during radiotherapy in cervical cancer patients receiving concurrent radiochemotherapy,and improves healthy behavior of patients.
引文
[1]周晖,刘昀昀,林仲秋.《2017 NCCN宫颈癌临床实践指南》解读[J].中国实用妇科与产科杂志,2017,33(1):100-107.
[2]National Comprehensive Cancer Network.Cervical Can-cer[EB/OL].(2017-10-25)[2018-10-07].https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf.
[3]Ryan J L.Ionizing radiation:the good,the bad,and the ugly[J].J Invest Dermatol,2012,132(3):985-993.
[4]Fisher J,Scott C,Stevens R,et al.Randomised phaseⅢstudy comparing best supportive care to biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation:radiation therapy oncology group[J].Int J Radiat Oncol Biol Phys,2000,48(5):1307-1310.
[5]Sheila K M,Mary E W,Carole H,et al.A case study to evaluate a new soft silicone dressing,Mepilex Lite,for patients with radiation skin reactions[J].Cancer Nurs,2008,31(1):9-14.
[6]谢秀荣,邱圣红,黄秀兰,等.乳酸依沙吖啶湿敷治疗宫颈癌放疗所致会阴部放射性皮炎的疗效观察[J].护理研究,2016,30(2):240-242.
[7]Maddock-Jennings W,Wilkinson J M,Shillington D.Novel approaches to radiation-induced skin reactions:a li-terature review[J].Complement Ther Clin Pract,2005,11(4):224-231.
[8]中华人民共和国卫生和计划生育委员.职业性放射性皮肤损伤诊断(GBZ 106-2016)[S].2016.
[9]Cox J D,Stetz J,Pajak T F.Toxicity criteria of the Radiation Therapy Oncology Group(RTOG)and the European Organization for Research and Treatment of Cancer(EORTC)[J].Int J Radiat Oncol Biol Phys,1995,31(5):1341-1346.
[10]陈春青,鲍哲,占习双,等.蛇黄洗剂会阴冲洗在经尿道术后留置导尿患者中的应用[J].护士进修杂志,2017,32(15):1392-1394.
[11]刘瑛,李丽莎,谢逢安,等.医用射线防护剂可减轻头颈部鳞癌患者的放疗皮肤损伤[J].南方医科大学学报,2016,36(3):443-444.
[12]朱莺,陈小芳,陈燕,等.奥克喷联合藻酸盐治疗宫颈癌Ⅲ度放射性皮炎的效果[J].中华现代护理杂志,2015,21(20):2459-2460,2461.
[13]赵丽芹.标准化护理程序在妇产科住院患者阴道灌洗护理中的应用[J].护理实践与研究,2016,13(18):8-10.
[14]李志珍,王继秋,李明芹.标准化护理在血流感染中的应用[J].中华医院感染学杂志,2014,24(15):3757-3758.
[15]陶然,陈利群,吴俊梅,等.标准化镇静护理给药方案的制订及在ICU患者镇静治疗中的应用[J].护理学杂志,2013,28(9):1-4.
[16]黄梨花.标准化皮肤护理干预对乳腺癌放射治疗后皮肤损害修复的影响[J].护理实践与研究,2017,14(14):105-107.
[17]沈永菊,翁剑侠,葛允荣,等.标准化皮肤护理干预对乳腺癌放疗后皮肤损害的疗效观察[J].中华全科医学,2016,14(5):858-859,878.
[18]陈英,张芬,杨凤华,等.护理干预对乳腺癌术后IMRT放疗皮肤损伤的影响[J].中国实用医药,2014,9(14):195-196.
[19]胡红珍,魏春霞,李丽萍,等.复发性外阴阴道假丝酵母菌病发病的相关因素[J].广东医学,2016(z2):167-169.
[20]李静雅,李蕾.环境因素对初产妇泌乳量影响的调查研究[J].中国妇幼保健,2013,28(23):3817-3818.
[21]邓娟,范玲.护理质量管理信息化研究进展[J].护理学杂志,2015,30(5):102-106.(本文编辑王菊香)
[2]National Comprehensive Cancer Network.Cervical Can-cer[EB/OL].(2017-10-25)[2018-10-07].https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf.
[3]Ryan J L.Ionizing radiation:the good,the bad,and the ugly[J].J Invest Dermatol,2012,132(3):985-993.
[4]Fisher J,Scott C,Stevens R,et al.Randomised phaseⅢstudy comparing best supportive care to biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation:radiation therapy oncology group[J].Int J Radiat Oncol Biol Phys,2000,48(5):1307-1310.
[5]Sheila K M,Mary E W,Carole H,et al.A case study to evaluate a new soft silicone dressing,Mepilex Lite,for patients with radiation skin reactions[J].Cancer Nurs,2008,31(1):9-14.
[6]谢秀荣,邱圣红,黄秀兰,等.乳酸依沙吖啶湿敷治疗宫颈癌放疗所致会阴部放射性皮炎的疗效观察[J].护理研究,2016,30(2):240-242.
[7]Maddock-Jennings W,Wilkinson J M,Shillington D.Novel approaches to radiation-induced skin reactions:a li-terature review[J].Complement Ther Clin Pract,2005,11(4):224-231.
[8]中华人民共和国卫生和计划生育委员.职业性放射性皮肤损伤诊断(GBZ 106-2016)[S].2016.
[9]Cox J D,Stetz J,Pajak T F.Toxicity criteria of the Radiation Therapy Oncology Group(RTOG)and the European Organization for Research and Treatment of Cancer(EORTC)[J].Int J Radiat Oncol Biol Phys,1995,31(5):1341-1346.
[10]陈春青,鲍哲,占习双,等.蛇黄洗剂会阴冲洗在经尿道术后留置导尿患者中的应用[J].护士进修杂志,2017,32(15):1392-1394.
[11]刘瑛,李丽莎,谢逢安,等.医用射线防护剂可减轻头颈部鳞癌患者的放疗皮肤损伤[J].南方医科大学学报,2016,36(3):443-444.
[12]朱莺,陈小芳,陈燕,等.奥克喷联合藻酸盐治疗宫颈癌Ⅲ度放射性皮炎的效果[J].中华现代护理杂志,2015,21(20):2459-2460,2461.
[13]赵丽芹.标准化护理程序在妇产科住院患者阴道灌洗护理中的应用[J].护理实践与研究,2016,13(18):8-10.
[14]李志珍,王继秋,李明芹.标准化护理在血流感染中的应用[J].中华医院感染学杂志,2014,24(15):3757-3758.
[15]陶然,陈利群,吴俊梅,等.标准化镇静护理给药方案的制订及在ICU患者镇静治疗中的应用[J].护理学杂志,2013,28(9):1-4.
[16]黄梨花.标准化皮肤护理干预对乳腺癌放射治疗后皮肤损害修复的影响[J].护理实践与研究,2017,14(14):105-107.
[17]沈永菊,翁剑侠,葛允荣,等.标准化皮肤护理干预对乳腺癌放疗后皮肤损害的疗效观察[J].中华全科医学,2016,14(5):858-859,878.
[18]陈英,张芬,杨凤华,等.护理干预对乳腺癌术后IMRT放疗皮肤损伤的影响[J].中国实用医药,2014,9(14):195-196.
[19]胡红珍,魏春霞,李丽萍,等.复发性外阴阴道假丝酵母菌病发病的相关因素[J].广东医学,2016(z2):167-169.
[20]李静雅,李蕾.环境因素对初产妇泌乳量影响的调查研究[J].中国妇幼保健,2013,28(23):3817-3818.
[21]邓娟,范玲.护理质量管理信息化研究进展[J].护理学杂志,2015,30(5):102-106.(本文编辑王菊香)