鼻咽癌出院患者放疗毒副反应变化趋势研究  

Changes in Trends of Toxic Side Effects of Radiotherapy in Discharged Patients with Nasopharyngeal Carcinoma

作　　者：廖婷婷 杨丽[2] 邱丽燕 黄玉萍[1] 李琳 孙烯辉 LIAO Tingting;YANG Li;QIU Liyan;HUANG Yuping;LI Lin;SUN Xihui(Department of Radiotherapy,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Nursing,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院放疗科,广西壮族自治区南宁市530021 [2]广西医科大学第一附属医院护理部,广西壮族自治区南宁市530021

出　　处：《中国全科医学》2020年第26期3330-3336,共7页Chinese General Practice

基　　金：广西医疗卫生适宜技术研究与开发课题(S201413-02);中央引导地方科技发展专项(桂科ZY18076006)。

摘　　要：背景放疗是目前鼻咽癌(NPC)患者的最优治疗方式,但放疗对放射区组织或器官的损害广泛且持久,而目前大多数研究仅是概述其毒副反应的种类及频率,对其随时间的具体变化趋势的研究较少。目的分析NPC患者出院后放疗毒副反应的发生频率、程度及变化趋势。方法 2018年12月-2019年3月采用便利抽样方法选取在广西医科大学第一附属医院NPC放化疗结束出院且经门诊复查的322例患者为调查对象,根据放疗结束时间将其为5组:≤6个月组、>6~12个月组、>1~3年组、>3~5年组、>5年组。观察其放疗毒副反应口干、鼻塞、耳鸣、听力下降、张口困难、颈部纤维化、放射性龋齿、头晕头痛、口腔溃疡、放射性皮炎等的发生率及严重程度,采用Spearman秩相关分析各放疗毒副反应随出院时间的变化趋势。结果 NPC患者出院后常见放疗晚期毒副反应口干、鼻塞、耳鸣、听力下降、张口困难、颈部纤维化、放射性龋齿、头晕头痛、口腔溃疡、放射性皮炎发生率分别为95.3%(307/322)、43.8%(141/322)、45.7%(147/322)、44.7%(144/322)、17.4%(56/322)、14.3%(46/322)、44.7%(144/322)、20.5%(66/322)、2.8%(9/322)、2.2%(7/322)。NPC患者出院后随出院时间的延长,鼻塞发生率降低,张口困难、颈部纤维化、头晕头痛发生率升高(P<0.05)。≤6个月组出现口腔溃疡9例(10.6%)、放射性皮炎7例(8.1%),其他组均未出现口腔溃疡及放射性皮炎。Spearman秩相关分析结果显示,NPC患者出院后口干(rs=-0.393,P<0.001)、鼻塞严重程度(rs=-0.314,P<0.001)与出院时间呈负相关,张口困难(rs=0.133,P=0.017)、放射性龋齿严重程度(rs=0.112,P=0.044)与出院时间呈正相关。出现颈部纤维化的NPC患者,颈部纤维化的严重程度均为1级。结论随着出院时间的延长,口干、耳鸣、听力下降仍保持较高的发生率,放射性龋齿、张口困难程度加重;口干、鼻塞程度减轻。Background Radiotherapy is the most appropriate treatment for patients with nasopharyngeal carcinoma(NPC)currently,but the damage of radiotherapy to tissues or organs in the radiation area is extensive and long-lasting.However,most related studies only summarize the types and frequencies of toxic side effects of NPC,and less involve the specific change trend of such effects over time.Objective To analyze the frequency,severity and development trend of toxic side effects of radiotherapy in discharged NPC patients.Methods From December 2018 to March 2019,322 NPC patients were selected by convenient sampling,who were discharged from the First Affiliated Hospital of Guangxi Medical University after radiotherapy and chemotherapy and passed the outpatient reexamination.They were divided into 5 groups according to the duration from the ending time of radiotherapy to the starting time of this study:≤6 months,>6-12 months,>1-3 years,>3-5 years,and>5 years.The incidence and level of toxic side effects of radiotherapy such as dry mouth,nasal congestion,tinnitus,hearing loss,trismus,neck fibrosis,radiation dental caries,dizziness and headache,oral ulcers,and radiation dermatitis in each group were collected,and the development trend of each side effect was analyzed by Spearman rank correlation analysis.Results The incidence of the common advanced toxic side effects of dry mouth,nasal congestion,tinnitus,hearing loss,trismus,neck fibrosis,radiation dental caries,dizziness and headache,oral ulcers,and radiation dermatitis was collected as 95.3%(307/322),43.8%(141/322),45.7%(147/322),44.7%(144/322),17.4%(56/322),14.3%(46/322),44.7%(144/322),20.5%(66/322),2.8%(9/322),and 2.2%(7/322),respectively.With the prolongation of discharged time,the incidence of nasal congestion decreased,but the incidence of trismus,fibrosis of the neck,and dizziness and headache increased(P<0.05).Oral ulcers(9 cases,10.6%)and radiation dermatitis(7 cases,8.1%)were only found in the≤6 months group.Spearman rank correlation analysis showed that the se

关 键 词：鼻咽肿瘤 放疗 毒副反应 变化趋势 药物毒性 化放疗 调查研究 

分 类 号：R739.63[医药卫生—肿瘤]