PRECEDE模式对头颈部放疗患者口腔感染的影响  

Effect of PRECEDE on oral infections in patients with head and neck radiotherapy

作　　者：严芳 李庆 韩元华[2] 彭捷 

机构地区：[1]武汉华中科技大学附属同济医院肿瘤科放疗中心,湖北武汉430030 [2]武汉华中科技大学附属同济医院口腔科,湖北武汉430030 [3]武汉华中科技大学附属协和医院伽马刀中心,湖北武汉430030

出　　处：《中华医院感染学杂志》2018年第2期243-246,共4页Chinese Journal of Nosocomiology

摘　　要：目的探究PRECEDE模式对头颈部位放疗患者口腔感染的影响,为有效预防头颈部位放疗患者口腔感染提供相应依据。方法选取2013年1月-2016年1月医院收治的头颈部放疗患者168例,根据对口腔干预方式不同将患者分成对照组和试验组;所有患者均接受三维适形放疗(3D-CRT),治疗疗程由患者病情具体制定;对照组患者在放疗的基础上增加常规的预防方式,试验组在对照组患者治疗基础上增加PRECEDE模式干预,干预两周后,比较两组患者真菌检出情况及构成比、口腔及肺部真菌感染率、口腔并发症(口臭、牙龈肿痛、口腔溃疡、真菌斑)发生率和口腔pH值。结果两组患者真菌检出类型主要为热带假丝酵母、克柔假丝酵母、白假丝酵母、光滑假丝酵母及其他真菌;试验组患者检出33株,对照组患者检出81株,对照组检出株数高于试验组(P<0.05);试验组患者口腔真菌感染率为11.90%,对照组患者口腔真菌感染率为21.43%,试验组低于对照组(P<0.05);试验组患者肺部真菌感染率为1.19%,对照组患者肺部真菌感染率为14.29%,试验组低于对照组(P<0.05);干预治疗后试验组患者中口臭、牙龈肿痛、口腔溃疡、真菌斑等口腔并发症发生率均低于对照组患者(P<0.05);试验组患者与对照组患者在干预前口腔pH值比较差异无统计学意义,干预后7、14d试验组患者口腔pH值为(7.6±0.3、8.2±0.2),高于对照组(3.7±0.2、4.6±0.1)两组比较差异有统计学意义(P<0.05)。结论 PRECEDE模式干预能够有效降低头颈部位放疗患者发生口腔感染率,减少患者口腔内真菌数量,提高口腔的pH值,效果显著,值得临床推广。OBJECTIVE To explore the effect of PRECEDE on oral infections in head and neck radiotherapy patients,so as to provide the basis for effective prevention of oral infections in patients with head and neck radiotherapy.METHODS A total of 168 cases of patients with head and neck radiotherapy in our hospital from Jan.2013 to Jan.2016 were selected,and were divided into control group and experimental group according to the different oral intervention methods.All patients were received three-dimensional conformal radiotherapy（3 D-CRT）,and the treatment course was specially formulated by the patient′s condition.The patients in control group were treated with the conventional prevention mode on the basis of radiotherapy,and in experimental group were treated PRECEDE mode of intervention on the basis of control group.After two weeks of intervention,the distribution and composition ratio of fungi,the infection rate of oral and pulmonary fungi,the rate of oral complications（halitosis,gingival swelling and pain,oral ulcers,and fungal spots）and oral pH between the two groups were observed and compared.RESULTS The main types of detected fungi in the two groups were Candida tropics,Candida korou,Candida albicans,Candida smooth and other fungi.C Totally 33 strains of fungi were detected in experimental group and 81 strains were detected in control group.The number of control group was higher than experimental group,and there was significant difference between two groups（P〈0.05）.The infection rates of fungal infections were 11.90%in experimental group and 21.43%in control group,and the rate of experimental group was significantly lower than that of control group（P〈0.05）.The pulmonary fungal infection rate in experimental group was 1.19%,in control group was 14.29%,and the rate of experimental group was significantly lower than that of control group（P〈0.05）.After the prevention of treatment,the rates of oral complications（halitosis,gingival swelling and pain,oral ulcers,and fungal spots）in experiment

关 键 词：PRECEDE模式 头颈部位 肿瘤 放疗 口腔感染 

分 类 号：R651[医药卫生—外科学]