H2H规范化鼻腔冲洗管理模式在鼻咽癌放疗患者中的应用

李艳青; 黄晓艳; 蒋青玉; 刘翠容; 翁敬锦

doi:10.16766/j.cnki.issn.1674-4152.004473

H2H规范化鼻腔冲洗管理模式在鼻咽癌放疗患者中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004473

广西壮族自治区人民医院耳鼻咽喉头颈科，广西南宁 530021

基金项目:

广西壮族自治区卫健委自筹经费科研课题 Z20200481

广西壮族自治区卫健委自筹经费科研课题 Z-A20220018

广西中医药管理局自筹课题 GXZYZ20210426

“四大慢病”国家科技重大专项课题 2025ZD0544204

详细信息

通讯作者:
刘翠容，E-mail：553427914@qq.com

中图分类号: R739.6 R815
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出版历程
- 收稿日期: 2025-07-18

Application of H2H standardized nasal irrigation management model in radiotherapy patients with nasopharyngeal carcinoma

Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China

摘要

摘要: 目的探讨H2H规范化鼻腔冲洗管理模式对鼻咽癌放疗患者鼻腔状况的影响，为放疗后鼻腔护理提供参考。方法选择2021年1月—2022年12月在广西壮族自治区人民医院耳鼻咽喉头颈科行放射治疗的128例鼻咽癌患者为研究对象，按照随机数字表法分为对照组和观察组，每组各64例。2组在治疗期间均予常规鼻腔冲洗护理，观察组在此基础上，从首次鼻腔冲洗开始至出院后6个月实施H2H规范化鼻腔冲洗管理模式，从医院到家庭提供连续的个体化护理。比较2组患者不同阶段对鼻腔冲洗的依从性、鼻腔分泌物黏稠度、放射性鼻窦炎发生部位及生活质量(SONT-20量表)。结果随访至出院后6个月，2组患者鼻腔冲洗依从性及生活质量比较，差异均有统计学意义(P＜0.05)；观察组鼻腔分泌物黏稠度(重度)为40.63%(26/64)，低于对照组的62.50%(40/64，P＜0.05)；观察组放射性鼻窦炎发生部位(≥3)为28.13%(18/64)，低于对照组的40.63%(26/64，P=0.062)。结论 H2H规范化鼻腔冲洗管理模式可有效提高鼻咽癌患者鼻腔冲洗的依从性，改善患者放疗后鼻腔状况，减轻患者放射性鼻窦炎严重程度，继而提高生活质量。
- 鼻咽癌放疗 /
- 鼻腔冲洗 /
- H2H模式 /
- 鼻腔分泌物 /
- 放射性鼻窦炎
Abstract: Objective To explore the effect of H2H standardized nasal irrigation management mode on the nasal condition of patients with nasopharyngeal carcinoma after radiotherapy, and to provide a reference for nasal care after radiotherapy. Methods A total of 128 patients with nasopharyngeal carcinoma who received radiotherapy in the Department of Otolaryngology and Head and Neck of Guangxi Zhuang Autonomous Region People's Hospital from January 2021 to December 2022 were selected as the study subjects, and were divided into a control group and an observation group according to a random number method, with 64 cases in each group. Both groups were given conventional nasal irrigation care during treatment. On this basis, the observation group was given H2H standardized nasal irrigation management mode from the first nasal irrigation to 6 months after discharge, and continuous individualized care was provided for patients from hospital to home. The compliance of nasal irrigation, the consistency of nasal secretions, the site of radioactive sinusitis, and the quality of life (SONT-20 scale) were compared between the two groups at different stages. Results Follow-up to 6 months after discharge, nasal irrigation compliance and quality of life between the two groups were statistically significant (P < 0.05);The viscosity (severe) of nasal secretions in the observation group was 40.63% (26/64), lower than that in the control group (62.5%, 40/64, P < 0.05); Site of radiation sinusitis (≥3) in the observation group was 28.13% (18/64), lower than that in the control group (40.63%, 26/64, P=0.062). Conclusion H2H standardized nasal irrigation management mode can effectively improve the compliance of nasal irrigation in nasopharyngeal carcinoma patients, improve the nasal condition of patients after radiotherapy, reduce the severity of radioactive sinusitis in patients, and improve the quality of life.
- Nasopharyngeal carcinoma radiotherapy /
- Nasal irrigation /
- H2H mode /
- Nasal secretions /
- Radiation sinusitis
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表 1 2组鼻咽癌患者一般资料比较

Table 1. Comparison of general characteristics between two groups of patients with nasopharyngeal carcinoma

组别	例数	性别(例)		年龄(x±s，岁)	文化程度(例)		医保类型(例)
组别	例数	男性	女性	年龄(x±s，岁)	初中及以下	高中及以上	城镇医保	市医保	中区医保
对照组	64	46	18	42.44±12.12	24	40	48	8	8
观察组	64	38	26	44.70±10.59	18	46	42	10	12
统计量		2.216^a		1.267^b	1.659^a		1.422^a
P值		0.137		0.262	0.646		0.491
注：^a为χ²值，^b为t值。

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表 2 2组鼻咽癌患者鼻腔冲洗依从性比较(x±s，分)

Table 2. Comparison of nasal irrigation compliance between two groups of patients with nasopharyngeal carcinoma (x±s, points)

组别	例数	首次鼻腔冲洗	出院时	出院后3个月	出院后6个月	F值	P值
对照组	64	4.80±0.48	3.80±0.95	2.53±0.94	1.89±0.88	180.990	＜0.001
观察组	64	4.91±0.29	4.58±0.73	3.62±1.40	2.56±1.28	72.010	＜0.001
F值		1.561	5.230	5.192	3.461
P值		0.121	＜0.001	＜0.001	＜0.001
注：与同组干预前比较，P＜0.001；出院时、出院后3个月、出院后6个月组间比较，P＜0.001。

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表 3 2组鼻咽癌患者鼻腔分泌物黏稠度比较[例(%)]

Table 3. Comparison of nasal secretion viscosity between two groups of patients with nasopharyngeal carcinoma [cases (%)]

组别	例数	首次鼻腔冲洗				出院时				出院后3个月				出院后6个月
组别	例数	0	Ⅰ	Ⅱ	Ⅲ	0	Ⅰ	Ⅱ	Ⅲ	0	Ⅰ	Ⅱ	Ⅲ	0	Ⅰ	Ⅱ	Ⅲ
对照组	64	14(21.88)	8(12.50)	4(6.25)	38(59.37)	10(15.63)	2(3.12)	13(20.31)	39(60.94)	14(21.88)	2(3.12)	6(9.38)	42(65.62)	12(18.75)	0(0.00)	12(18.75)	40(62.50)
观察组	64	22(34.38)	18(28.12)	6(9.38)	18(28.12)	12(18.75)	20(31.25)	6(9.38)	26(40.62)	20(31.25)	14(21.88)	10(15.62)	20(31.25)	34(53.13)	2(3.12)	2(3.12)	26(40.63)
Z值		3.118				2.573				3.320				3.375
P值		0.002				0.010				0.001				0.001

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表 4 2组鼻咽癌患者放射性鼻窦炎部位比较[例(%)]

Table 4. Comparison of radiation sinusitis sites between two groups of patients with nasopharyngeal carcinoma [cases (%)]

组别	例数	首次鼻腔冲洗				出院时				出院后3个月				出院后6个月
组别	例数	0	1~2	3~4	>4	0	1~2	3~4	>4	0	1~2	3~4	>4	0	1~2	3~4	>4
对照组	64	24(37.50)	24(37.50)	15(23.44)	1(1.56)	16(25.00)	26(40.62)	16(25.00)	6(9.38)	12(18.75)	26(40.62)	20(31.25)	6(9.38)	10(15.62)	28(43.75)	18(28.13)	8(12.50)
观察组	64	24(37.50)	36(56.25)	2(3.13)	2(3.13)	16(25.00)	40(62.50)	8(12.50)	0	8(12.50)	48(75.00)	8(12.50)	0	10(15.62)	36(56.25)	18(28.13)	0
Z值		1.394				1.859				2.102				1.870
P值		0.163				0.063				0.036				0.062

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表 5 2组鼻咽癌患者生活质量(SONT-20量表)比较[M(P₂₅，P₇₅)]

Table 5. Comparison of quality of life (SONT-20 scale) between two groups of patients with nasopharyngeal carcinoma [M(P₂₅, P₇₅)]

组别	例数	首次鼻腔冲洗	出院时	出院后3个月	出院后6个月	Friedman χ²值	P值
对照组	64	5.00(1.00, 10.00)	9.00(5.00, 10.00)	7.00 (3.00, 10.00)	7.00(1.00, 10.00)	101.463	＜0.001
观察组	64	5.00(1.00, 10.00)	9.00(5.00, 10.00)	7.00 (3.00, 10.00)	7.00(1.00, 10.00)	66.281	＜0.001
Z值		-0.315	-8.159	-5.225	-4.718
P值		0.749	＜0.001	＜0.001	＜0.001
注：组间比较采用Mann-Whitney U检验；组内不同时间点比较采用Friedman检验。

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参考文献(20)

[1]	瞿申红, 翁敬锦, 韦嘉章. 广西地区鼻咽癌防治概况与展望[J]. 中国临床新医学, 2021, 14(7): 633-641. QU S H, WENG J J, WEI J Z. Overview and prospect of prevention and treatment of nasopharyngeal carcinoma in Guangxi region[J]. Chinese Journal Of New Clinical Medicine, 2021, 14(7): 633-641.
[2]	中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会. 中国鼻咽癌放射治疗指南(2020版)[J]. 中华肿瘤防治杂志, 2021, 28(3): 167-177. Radiation Oncology Branch of Chinese Medical Doctor Association, Radiation Oncology Branch of Chinese Medical Association. Chinese guideline for radiotherapy of nasopharyngeal carcinoma (2020 edition)[J]. Chinese Journal of Oncology Prevention and Treatment, 2021, 28(3): 167-177.
[3]	欧阳天斌. 鼻咽癌患者调强放射治疗后鼻窦炎的临床特征分析[J]. 中国眼耳鼻喉科杂志, 2023, 23(1): 44-48. OUYANG T B. Clinical features of sinusitis after intensity modulated radiotherapy in patients with nasopharyngeal carcinoma[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2023, 23(1): 44-48.
[4]	刘家欢, 韩雨, 杨洋, 等. "H2H"营养管理模式对胃癌根治术后病人营养状况和生活质量的影响[J]. 肠外与肠内营养, 2022, 29(2): 116-120. LIU J H, HAN Y, YANG Y, YE X H, LI G L, XIANG X S, et al. "H2H" nutrition management mode on the nutritional status and quality of life of patients with gastric cancer after radical surgery[J]. Parenteral & Enteral Nutrition, 2022, 29(2): 116-120.
[5]	胡娟, 曾凡. "H2H"营养管理模式对食管癌放疗患者营养状况、生活质量及并发症的影响[J]. 国际护理学杂志, 2022, 41(10): 1792-1795. HU J, ZENG F. Effects of "H2H" nutrition management model on nutritional status, quality of life and complications of patients with esophageal cancer undergoing radiotherapy[J]. International Journal of Nursing, 2022, 41(10): 1792-1795.
[6]	VAN DE RIET L, ALSEM M W, VAN DER LEEST E C, et al. Delineating family needs in the transition from hospital to home for children with medical complexity: part 1, a meta-aggregation of qualitative studies[J]. Orphanet J Rare Dis, 2023, 18(1): 386. DOI: 10.1186/s13023-023-02942-9.
[7]	LIU X, LI X, LIU Y L, et al. H2H rehabilitation care promotes high quality recovery of patients with lung cancer comorbid with chronic obstructive pulmonary disease[J]. Am J Cancer Res, 2023, 13(10): 4613-4622.
[8]	高兴, 底瑞青, 叶琳, 等. 慢性鼻窦炎患者鼻腔冲洗护理实践最佳证据总结[J]. 护理学杂志, 2023, 38(11): 27-32. GAO X, DI R Q, YE L, JIN Z C, et al. Summary of the best evidence for nursing practice of nasal irrigation in chronic sinusitis patients[J]. Journal of Nursing Science, 2023, 38(11): 27-32.
[9]	卢佳美, 杨丽, 黄晓君, 等. 网络平台延续健康管理在鼻咽癌出院病人延续护理中的应用[J]. 护理研究, 2020, 34(20): 3587-3593. LU J M, YANG L, HUANG X J, LIAO J L, PAN D M, TANG Q M, LYU J, HU K, LIANG L M, TANG Q H, et al. Application of continuous health management through internet platform in continuity of care of discharged patients with nasopharyngeal carcinoma[J]. Chinese Nursing Research, 2020, 34(20): 3587-3593.
[10]	陈询. 闭合式鼻咽冲洗法对鼻咽癌放疗患者鼻咽分泌物黏稠度的影响[J]. 中外医学研究, 2020, 18(23): 128-130. CHEN X. Effect of closed nasopharyngeal irrigation on the viscosity of nasopharyngeal secretions in patients undergoing radiotherapy for nasopharyngeal carcinoma[J]. Chinese and Foreign Medical Research, 2020, 18(23): 128-130.
[11]	符雯, 罗焯瀛, 彭华. 鼻咽癌放射性鼻窦炎流行病学和影像学评估研究进展[J]. 局解手术学杂志, 2023, 32(4): 358-362. FU W, LUO Z Y, PENG H. Research progress on epidemiology and imaging assessment of radiation sinusitis in nasopharyngeal carcinoma[J]. Journal of Regional Anatomy and Operative Surgery, 2023, 32(4): 358-362.
[12]	王哲培, 聂晟, 赵继匡, 等. 内镜下经鼻垂体腺瘤术后应用鼻腔清创术的临床效果及对鼻部症状、生活质量的中远期影响[J]. 中国耳鼻咽喉头颈外科, 2022, 29(10): 673-676. WANG Z P, NIE S, ZHAO J K, et al. Clinical effects of postoperative nasal debridement after endoscopic transnasal pituitary adenoma resection and its mid-to-long-term effects on nasal symptoms and quality of life[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2022, 29(10): 673-676.
[13]	朱海婷, 顾冬梅. 鼻咽癌放疗患者出院后康复训练依从性的影响因素调查[J]. 护理学杂志, 2021, 36(14): 91-94. ZHU H T, GU D M. Investigation on influencing factors of rehabilitation training compliance in nasopharyngeal carcinoma patients after discharge following radiotherapy[J]. Journal of Nursing Science, 2021, 36(14): 91-94.
[14]	文珂, 陈佩娟, 何玉. 成人鼻咽癌放疗病人张口锻炼依从性影响因素及与自我管理效能的关系[J]. 护理研究, 2021, 35(24): 4419-4423. WEN K, CHEN P J, HE Y. Influencing factors of mouth opening exercise compliance and its relationship with self-management efficacy in adult nasopharyngeal carcinoma patients undergoing radiotherapy[J]. Nursing Research, 2021, 35(24): 4419-4423.
[15]	王志敏, 何佩仪, 杜萍. 专科护理门诊延续跟进式赋能教育对鼻咽癌放疗患者康复的影响[J]. 中国护理管理, 2020, 20(1): 107-111. WANG Z M, HE P Y, DU P. Effect of continuous follow-up empowering education in specialist nursing clinics on rehabilitation of nasopharyngeal carcinoma patients undergoing radiotherapy[J]. Chinese Nursing Management, 2020, 20(1): 107-111.
[16]	章汝, 章小华, 傅国萍, 等. 自我效能理论主导的靶向训练对脑卒中患者运动功能及日常生活能力的影响[J]. 中华全科医学, 2024, 22(5): 805-808, 832. ZHANG R, ZHANG X H, FU G P, YU D H, HE R, et al. The impact of targeted training led by self-efficacy theory on motor function and daily living ability of stroke patients[J]. Chinese Journal of General Practice, 2024, 22(5): 805-808, 832.
[17]	闫珊, 沈慧, 顾智淳, 等. 新型智慧化管理模式在心房颤动患者社区随访管理中的效果评价[J]. 中华全科医学, 2024, 22(6): 1008-1012. YAN S, SHEN H, GU Z C, PAN M M, WANG X H, YE A X, et al. Evaluation of the effect of a new intelligent management model in community follow-up management of patients with atrial fibrillation[J]. Chinese Journal of General Practice, 2024, 22(6): 1008-1012.
[18]	李霞, 侯冉, 王丽萍. 基于Web of Science近10年鼻腔冲洗治疗鼻腔疾病的文献计量学分析[J]. 山东大学耳鼻喉眼学报, 2024, 38(2): 52-60. LI X, HOU R, WANG L P. Bibliometric analysis of nasal irrigation for nasal diseases in the past 10 years based on Web of Science[J]. Journal of Shandong University (Otolaryngology and Ophthalmology), 2024, 38(2): 52-60.
[19]	罗山泉, 石梅, 王建华, 等. 鼻腔鼻窦癌调强放疗后放射性鼻窦炎与鼻窦黏膜照射剂量-体积关系分析[J]. 现代肿瘤医学, 2020, 28(20): 3521-3524. LUO S Q, SHI M, WANG J H, et al. Analysis of the relationship between radiation sinusitis and irradiation dose-volume of sinus mucosa after intensity-modulated radiotherapy for nasal cavity and paranasal sinus cancer[J]. Modern Oncology Journal, 2020, 28(20): 3521-3524.
[20]	梁秋婷, 杨丽, 李家燕, 等. 鼻咽癌放化疗致慢性鼻窦炎患者症状困扰分析[J]. 护理学杂志, 2024, 39(2): 47-51. LIANG Q T, YANG L, LI J Y, et al. Analysis of symptom distress in patients with chronic sinusitis caused by radiotherapy and chemotherapy for nasopharyngeal carcinoma[J]. Journal of Nursing Science, 2024, 39(2): 47-51.