两种化疗相关性口腔炎评估工具在急性白血病患儿中的应用比较  

Comparison of the application of two chemotherapy-induced oral mucositis assessment tools in children with acute leukemia

作　　者：葛铮铮 张晓艳 沈南平[2] 孙霁雯 何梦雪 Ge Zhengzheng;Zhang Xiaoyan;Shen Nanping;Sun Jiwen;He Mengxue(Department of Hematology Oncology,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;Nursing Department,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心血液肿瘤科,200127 [2]上海交通大学医学院附属上海儿童医学中心护理部,200127

出　　处：《中华现代护理杂志》2021年第30期4129-4133,共5页Chinese Journal of Modern Nursing

基　　金：上海儿童医学中心院基金(YJ-SCMC2018-10);上海市教委护理高原学科项目(hlgy1805kyx;hlgy1802sjk)。

摘　　要：目的比较不同化疗相关性口腔炎评估工具之间的评估能力,寻求适合我国儿童及青少年、可信、可靠、敏感性高、特异性强的化疗相关性口腔炎评估工具。方法采用便利抽样法,选择2019年7月—2020年6月上海儿童医学中心血液肿瘤病区的88例患儿,在化疗前(T1:化疗疗程开始前)、化疗初期(T2:化疗开始第1~3天)、化疗后期(T3:化疗开始第4天及以后)这3个时间段,使用中文版国际儿童口腔炎评估表(ChIMES)、口腔评估指南(OAG)以及WHO口腔炎分级对所有患儿进行评估。以WHO口腔炎分级结果作为金标准,采用敏感度、特异度和ROC及曲线下面积(AUC)等指标评价ChIMES和OAG的评估能力及最佳临界值,并比较3种工具的评估耗时。结果ChIMES和OAG在化疗期间3次评分之间差异均有统计学意义(P<0.05)。以WHO口腔炎分级为金标准,ChIMES最佳临界值为0.5,OAG最佳临界值为10.5。ChIMES和OAG用于儿童化疗相关性口腔炎的评估能力均非常优秀(AUC>0.9)。WHO口腔炎分级、ChIMES、OAG 3种工具使用耗时比较,差异有统计学意义(P<0.05)。结论ChIMES和OAG均可作为我国儿童化疗相关性口腔炎评估的可信、可靠工具。ChIMES对高危人群的鉴别能力高于OAG;OAG更适用于繁忙的临床工作中。故可根据评估对象、目的、所需资源等方面分析,选择儿童化疗相关性口腔炎评估工具。Objective To compare the capabilities of different chemotherapy-induced oral mucositis assessment tools,and seek a credible,reliable,highly sensitive and specific chemotherapy-induced oral mucositis assessment tool suitable for children and adolescents in China.Methods From July 2019 to June 2020,convenience sampling was used to select 88 children from the Department of Hematology Oncology of Shanghai Children's Medical Center.The Chinese version of Children's International Mucositis Evaluation Scale (ChIMES), Oral Assessment Guide (OAG), and World Health Organization (WHO) oral mucositis classificationwere evaluated for all children in the three time periods, namely, before chemotherapy (T1: before the start ofchemotherapy), early chemotherapy (T2: the first to third days of chemotherapy), and late chemotherapy (T3:the fourth day of chemotherapy and after). Taking the result of WHO oral mucositis classification as the goldstandard, and indicators such as sensitivity, specificity, relative operating characteristic (ROC), and area underthe curve (AUC) were used to evaluate the capabilities and optimal cut-off values of ChIMES and OAG, andthe evaluation time-consuming of the three tools was compared. Results There were statistically significantdifferences between ChIMES and OAG in the three scores during chemotherapy (P < 0.05). Taking the WHOoral mucositis classification as the gold standard, the optimal cut-off value for ChIMES was 0.5, and the optimalcut-off value for OAG was 10.5. Both ChIMES and OAG had excellent assessment capabilities for children withchemotherapy-induced oral mucositis (AUC > 0.9). The time-consuming comparison of WHO oral mucositisclassification, ChIMES and OAG was statistically significant (P<0.05). Conclusions Both ChIMES and OAGcan be used as credible and reliable tools for the assessment of chemotherapy-induced oral mucositis of childrenin China. ChIMES is more capable of identifying high-risk groups than OAG, and OAG is more suitable forbusy clinical work. The assessment tool for chil

关 键 词：儿童 血液肿瘤 化疗相关性口腔炎 国际儿童口腔炎评估表 口腔评估指南 测量学研究 

分 类 号：R473.73[医药卫生—护理学]