早期系统化护理对食管癌放疗患者的影响研究

陆宏; 耿春花; 肖彬; 汪毅; 许阳

doi:10.16766/j.cnki.issn.1674-4152.002031

早期系统化护理对食管癌放疗患者的影响研究

doi: 10.16766/j.cnki.issn.1674-4152.002031

合肥市第一人民医院滨湖院区肿瘤科，安徽合肥 230601

基金项目:

安徽省省级引才引智重点项目 S20193400016

合肥市卫健委应用医学研究重点项目 hwk2017zd013

详细信息

通讯作者:
陆宏，E-mail：1262212021@qq.com

中图分类号: R735.1 R730.55 R473.73
计量
- 文章访问数: 109
- HTML全文浏览量: 54
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2020-09-25
- 网络出版日期: 2022-02-16

Effects of early systematic care on patients with esophageal cancer undergoing radiotherapy

Department of Oncology, the Hefei Binhu Hospital, Hefei, Anhui 230601, China

摘要

摘要: 目的探讨早期系统化护理对食管癌放疗患者的影响。方法 2018年1月开始入组合肥市第一人民医院滨湖医院肿瘤科食管癌放疗患者，按随机数字表法随机分为对照组和观察组，截至2020年4月共入组46例，每组各23例。对照组、观察组患者分别接受常规护理和早期系统化护理。比较放疗期间的营养指标、生活质量、放射性食管炎(RE)/肺炎(RP)发生率以及血清炎症因子在2组间的差异。结果 2组患者基线数据比较差异无统计学意义(均P＞0.05)。观察组RE发生率为8.70%，明显低于对照组(39.13%，P＜0.05)；且观察组RP发生率(4.35%)较对照组(17.39%)低，但差异无统计学意义(P＞0.05)。观察组患者外周炎症因子IL-6、转化生长因子-β(TGF-β)、S100钙结合蛋白A8(S100A8)重组蛋白(S100A8)、IL-10水平较对照组低(均P＜0.05)。观察组患者健康调查简易量表(SF-36)生活质量总评分[(598.30±143.20)分]较对照组[(417.00±200.58)分]显著升高，观察组患者主要营养指标BMI、Hb、ALB、淋巴细胞计数(Lym)均明显高于对照组患者(均P＜0.05)。结论早期系统化护理能够改善食管癌放疗患者营养状态，抑制炎症因子释放，降低放射性食管炎发生率，提升生活质量。
- 系统化护理 /
- 食管癌 /
- 放射治疗 /
- 放射性食管炎 /
- 细胞因子 /
- 生活质量
Abstract: Objective To investigate the effects of early systematic nursing care on patients suffering from esophageal carcinoma and receiving radiotherapy. Methods From January 2018 to April 2020, we enrolled 46 patients with esophageal carcinoma and divided into two groups of 23 individuals at random. Usual care or early systematic nursing care was adopted for the control or study group.The nutrition index, quality of life, serum inflammatory factors, occurrence of radiation esophagitis (RE) and pneumonia (RP) were the indicators we used for comparison. Results All pieces of baseline information showed no obvious distinction between the two groups (all P>0.05). The incidence of RE was 8.70% and dramatically attenuated in patients who received early systematic nursing, as compared with that in the control group (39.13%, P < 0.05). As for RP, the incident rate was 4.35% in the study group and lower than that in the control (17.39%), but no distinct difference was observed (P>0.05). Patients who received early systematic nursing had remarkably lower serum IL-6, TGF-β, S100A8 and IL-10 levels than patients who received usual nursing (all P < 0.05). Quality of life with SF-36 showed that the total score of the study group [(598.30±143.20) points] was considerably improved when compared with that of the control group [(417.00±200.58) points]. Meanwhile, BMI, Hb, ALB and Lym in patients who received early systematic nursing were higher than those in the control group (all P < 0.05). Conclusion During radio therapy of patients with esophageal cancer, the early systematic nursing can improve nutritional status and inhibit the release of inflammatory cytokines and may thus be paramount in the suppression of radiation-induced esophagitis and improvement of patients' quality of life.
- Systematic nursing care /
- Esophageal cancer /
- Radiotherapy /
- Radioactive esophagitis /
- Cytokines /
- Quality of life

HTML全文

表 1 2组EC患者基线资料比较

组别	例数	性别(例)		年龄(x±s，岁)	部位(例)			临床分期(例)		放疗前BMI(x±s)	放疗前Hb(x±s，g/L)	放疗前Alb(x±s，g/L)	放疗前Lym(x±s，×10⁹/L)
组别	例数	男性	女性	年龄(x±s，岁)	胸上段	胸中段	胸下段	Ⅱ期	Ⅲ期	放疗前BMI(x±s)	放疗前Hb(x±s，g/L)	放疗前Alb(x±s，g/L)	放疗前Lym(x±s，×10⁹/L)
对照组	23	18	5	74.17±8.94	8	13	2	7	16	24.68±5.33	98.48±7.18	27.33±7.97	1.42±0.32
观察组	23	19	4	71.91±9.70	6	9	8	11	12	24.93±5.34	99.49±7.61	26.61±6.55	1.51±0.47
统计量		0.138^a		0.822^b	4.613^a			1.460^a		0.160^b	0.452^b	0.330^b	0.715^b
P值		0.710		0.416	0.111			0.227		0.874	0.654	0.743	0.478

组别	例数	放疗总剂量(x±s，cGy)		放疗前IL-6[M(P₂₅, P₇₅)，pg/mL]	放疗前TGF-β[M(P₂₅, P₇₅)，pg/mL]			放疗前IL-33[M(P₂₅, P₇₅)，pg/mL]			放疗前S100A8[M(P₂₅, P₇₅)，pg/mL]	放疗前IL-10[M(P₂₅, P₇₅)，pg/mL]
对照组	23	5 327.82±432.82		66.72(46.25，89.07)	1 709.84(839.48，1 193.56)			117.80(77.16，142.67)			96.98(55.92，143.46)	93.21(24.44，116.30)
观察组	23	5 411.30±478.89		61.07(38.75，87.41)	2 050.67(1 193.56，2 810.59)			116.00(95.68，141.16)			114.40(96.19，128.91)	88.56(60.34，118.77)
统计量		0.620^b		253.000^c	225.000^c			247.000^c			249.000^c	239.000^c
P值		0.538		0.805	0.392			0.707			0.739	0.582
注：^a为χ²值，^b为t值,^c为U值。

下载: 导出CSV

表 2 不同护理方式对EC患者放疗营养水平变化的影响(x±s)

组别	例数	放疗后BMI	放疗后Hb(g/L)	放疗后Alb(g/L)	放疗后Lym(×10⁹)
对照组	23	22.90±5.01	102.50±14.43	25.69±7.16	1.37±0.48
观察组	23	26.53±5.51	112.73±12.57	32.95±5.94	1.95±0.62
t值		2.283	2.503	3.657	3.457
P值		0.027	0.016	＜0.001	0.001

下载: 导出CSV

表 3 不同护理方式对RE及RP发生率及相关炎症因子水平变化的影响

组别	例数	放射性食管(例)		放射性肺炎(例)		放疗后IL-6(x±s，pg/mL)	放疗后TGF-β(x±s，pg/mL)	放疗后IL-33(x±s，pg/mL)	放疗后S100A8(x±s，pg/mL)	放疗后IL-10(x±s，pg/mL)
组别	例数	1~4级	0级	1~4级	0级	放疗后IL-6(x±s，pg/mL)	放疗后TGF-β(x±s，pg/mL)	放疗后IL-33(x±s，pg/mL)	放疗后S100A8(x±s，pg/mL)	放疗后IL-10(x±s，pg/mL)
对照组	23	9	14	4	19	114.52±55.10	2 957.65±804.61	154.75±43.12	173.57±67.14	165.21±81.90
观察组	23	2	21	1	22	71.74±39.64	2 315.37±874.40	132.64±52.14	134.02±60.33	117.93±68.03
统计量		5.855^a		2.020^a		2.956^b	2.535^b	1.532^b	2.055^b	2.083^b
P值		0.016		0.155		0.005	0.015	0.133	0.046	0.043
注：^a为U值，^b为t值。

下载: 导出CSV

表 4 2组EC患者SF-36评分的影响[M(P₂₅, P₇₅)，分]

组别	例数	生理机能	生理职能	躯体疼痛	一般健康状况	精力	社会功能	情感职能	精神健康	健康变化	总分
对照组	23	50(25，85)	0(0，50)	62(52，100)	30(25，50)	60(35，75)	67(33，78)	33(0，67)	56(40，80)	25(0，25)	410(298，551)
观察组	23	75(70，95)	50(25，100)	84(72，100)	57(42，72)	75(65，80)	78(78，89)	67(33，100)	72(64，80)	25(25，50)	614(492，731)
U值		172.500	148.500	171.000	139.500	172.500	123.000	153.500	172.500	156.500	117.000
P值		0.042	0.007	0.034	0.005	0.041	0.001	0.013	0.042	0.010	0.001

下载: 导出CSV

参考文献(22)

[1]	CHEN W, ZHENG R, BAADE P D, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132. doi: 10.3322/caac.21338
[2]	曹晓云, 武霞, 杨美伦. 重组人IL-11联合营养支持防治食管癌患者放射性食管炎提高其生活质量的作用[J]. 实用医药杂志, 2019, 36(7): 604-607. https://www.cnki.com.cn/Article/CJFDTOTAL-QEYY201907012.htm
[3]	王程浩, 韩泳涛. 2020年中国临床肿瘤学会《食管癌诊疗指南》解读[J]. 肿瘤预防与治疗, 2020, 33(4): 285-290. doi: 10.3969/j.issn.1674-0904.2020.04.001
[4]	YOUENS D, HALKETT G, WRIGHT C, et al. Assessing the cost-effectiveness of RT Prepare: A radiation therapist-delivered intervention for reducing psychological distress prior to radiotherapy[J]. Psychooncology, 2019, 28(5): 1110-1118. http://www.onacademic.com/detail/journal_1000042269724099_21df.html
[5]	张艳秋, 孙英. 早期营养支持治疗及护理干预对食管癌放化疗的影响[J]. 临床医药文献电子杂志, 2019, 6(98): 159-160. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWX201998105.htm
[6]	吕家华, 李涛. 食管癌放疗患者的营养治疗[J]. 肿瘤代谢与营养电子杂志, 2017, 4(2): 144-148. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLDX201702004.htm
[7]	吕家华, 李涛, 谢丛华, 等. 食管癌放疗患者肠内营养专家共识[J]. 肿瘤代谢与营养电子杂志, 2015, 2(4): 29-32. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLDX201504013.htm
[8]	周彬, 傅辰春, 孙新臣, 等. 老年食管鳞癌患者单纯放疗和同步放化疗的有效性和安全性比较[J]. 临床肿瘤学杂志, 2020, 25(2): 161-166. doi: 10.3969/j.issn.1009-0460.2020.02.012
[9]	周慧玲, 陈冰, 曾嘉彦, 等. 中文版SF-36量表在广东职业康复患者中信效度研究[J]. 康复学报, 2018, 28(3): 12-15. https://www.cnki.com.cn/Article/CJFDTOTAL-FYXB201803004.htm
[10]	刘瑞林, 徐国良. 系统化护理干预在慢性非细菌性前列腺炎患者中的应用效果[J]. 河南医学研究, 2020, 29(5): 925-927. doi: 10.3969/j.issn.1004-437X.2020.05.082
[11]	HOEBEN A, POLAK J, VAN DE VOORDE L, et al. Cervical esophageal cancer: A gap in cancer knowledge[J]. Ann Oncol, 2016, 27(9): 1664-1674. doi: 10.1093/annonc/mdw183
[12]	殷梅平. 并发症系统化护理干预在放疗联合化疗治疗肺癌中的应用价值探讨[J]. 基层医学论坛, 2016, 20(24): 3416-3417. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLT201624066.htm
[13]	CITAK E, TULEK Z, UZEL O. Nutritional status in patients with head and neck cancer undergoing radiotherapy: A longitudinal study[J]. Support Care Cancer, 2019, 27(1): 239-247. doi: 10.1007/s00520-018-4319-6
[14]	朱小平, 王燕, 何慧娟. 肠内营养与肠外营养对放疗食管癌患者的营养改善效果研究[J]. 中国药物与临床, 2019, 19(15): 2590-2592. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC201915037.htm
[15]	RIETVELD S C M, NIEROP W V, OTTENS-OUSSOREN K, et al. The prediction of deterioration of nutritional status during chemoradiation therapy in patients with esophageal cancer[J]. Nutr Cancer, 2018, 70(2): 229-235. doi: 10.1080/01635581.2018.1412481
[16]	QIU Y, YOU J, WANG K, et al. Effect of whole-course nutrition management on patients with esophageal cancer undergoing concurrent chemoradiotherapy: A randomized control trial[J]. Nutrition, 2020, 69: 110558. doi: 10.1016/j.nut.2019.110558
[17]	张云霞, 吴贤翠. 早期营养支持在头颈部肿瘤放化疗患者中的应用效果研究[J]. 实用临床护理学电子杂志, 2019, 4(32): 158. https://www.cnki.com.cn/Article/CJFDTOTAL-SLHL201932142.htm
[18]	谢华平, 王惠. 心理疏导结合感知控制对鼻咽癌放疗患者癌因性疲劳和生活质量的影响[J]. 中国健康心理学杂志, 2018, 26(9): 1329-1333. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL201809014.htm
[19]	王绿化, 傅小龙, 陈明, 等. 放射性肺损伤的诊断及治疗[J]. 中华放射肿瘤学杂志, 2015, 24(1): 4-9. doi: 10.3760/cma.j.issn.1004-4221.2015.01.003
[20]	SIWEN W, RUI S, ZIYI W, et al. S100A8/A9 in inflammation[J]. Front Immunol, 2018, 9: 1298. doi: 10.3389/fimmu.2018.01298
[21]	陈茜, 李红霞, 许阳, 等. 血清IL-6、TGF-β、IL-33及S100A8水平与放射性肺损伤的相关性研究[J]. 临床肺科杂志, 2018, 23(9): 1584-1589. doi: 10.3969/j.issn.1009-6663.2018.09.008
[22]	吴红艳, 马金晶. 针对性护理干预对老年腹腔镜结直肠癌根治术患者血清相关因子表达的影响[J]. 中国肿瘤临床与康复, 2019, 26(5): 610-613. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK201905042.htm