檢視不同漱口溶液對移植術後病人口腔炎之應用及成效：系統性文獻回顧

Application and Effectiveness of the Different Mouthwash Solutions on Oral Mucositis of Transplant Recipients: A Systematic Review

10.3966/102673012015032601002

蔡佩臻(Pei-Jen Tsai)；張嘉玲(Chia-Ling Chang)；林梅香(Mei-Hsiang Lin)；賀倫惠(Lun-Hui Ho)；邱綉玲(Hsiu-Ling Chiu)

口腔炎 ； 移植 ； 漱口溶液 ； oral mucositis ； transplant ； mouthwash solution

長庚護理

26卷1期（2015 / 03 / 01）

13 - 22

繁體中文

背景：口腔炎是化學治療與放射線治療後常見合併症之一，然而，當有口腔炎發生時，不但會影響其進食慾望，減少營養的攝取，且會影響組織細胞的修復。目的：透過系統性文獻回顧評讀比較能改善移植病人手術後口腔炎的漱口溶液成效，漱口溶液與口腔炎之發生率、口腔炎嚴重程度及持續時間的相關性。方法：搜尋資料庫中電子期刊包含CEPS、PudMed、Cochrance library、Medline等，以口腔炎、移植、口腔清潔、stomatitis、oral ulcer 、transplantation、mouthwash等為搜尋關鍵字，共獲得45篇相關文獻，扣除重複文獻，評讀摘要後剔除不適合本文主題者，最後共篩選出17篇文獻。結果：移植個案使用的漱口水包括Chlorhexidine、Glutamin、Povidone-iodine、Nystatin及葉酸等；其中又以Chlorhexidine之漱口溶液最有效。結論／實務應用：移植術後病人使用Chlorhexidine可明顯降低口腔炎發生率及其嚴重程度，故建議未來移植病人可以使用這種漱口溶液。

Background: Oral mucositis is a common complication after chemotherapy, radiation therapy. Oral mucositis will impact the desire appetite, decrease nutrient intake, and impede tissue repair. Purpose: This study was a systematic review. The purpose was to compare the effectiveness of different mouthwash solutions in organ transplantation patients. The relationships among mouthwash solution with incidence, severity, and duration of oral mucositis were analyzed. Methods: Literatures were searched from electronic database of CEPS, PudMed, Cochrance library, and Medline. Keywords including ＂oral mucositis＂ or ＂Stomatitis＂ and ＂transplantation＂ and ＂mouthwash＂ were keyed in, and 45 articles were extracted. Finally, 17 articles selected for further analysis after excluding repeated topics. Results: The mouthwash solution for transplant patients included Chlorhexidine, Glutamin, Povidoneiodine, Nystatin and folic acid. Chlorhexidine is the most effective mouthwash solution. Conclusions/Implications for practice: Transplant patients using Chlorhexidine can significantly reduce the incidence and severity of oral mucositis. Results of this review suggests Chlorhexidine mouthwash solution is the priority choice for transplant patients.

1. Anderson, P. M.,Ramsay, N. K.,Shu, X. O.,Rydholm, N.,Rogosheske, J.,Nicklow, R.,Skubitz, K. M.(1998).Effect of low-dose oral glutamine on painful stomatitis during bone marrow transplantation.Bone Marrow Transplant,22(4),339-344.
2. Bez, C.,Demarosi, F.,Sardella, A.,Lodi, G.,Bertolli, V. G.,Annaloro, C.,Carrassi, A.(1999).GM-CSF mouthrinses in the treatment of severe oral mucositis: A pilot study.Oral Surgery. Oral Medicine, Oral Pathology,88(3),311-315.
3. Bhatt, V.,Vendrell, N.,Nau, K.,Crumb, D.,Roy, V.(2010).Implementation of a standardized protocol for prevention and management of oral mucositis in patients undergoing hematopoietic cell transplantation.Journal of Oncology Pharmacy Practice,16(3),195-204.
4. Burckart, G. J.,Amur S.(2010).Update on the clinical pharmacogenomics of organ transplantation.Pharmacogenomics,11(2),227-36.
5. Cawley, M. M.,Benson, L. M.(2005).Current trends in managing oral mucositis Clinical journal of oncology nursing.Journal of oncology nursing,9(5),584-592.
6. Cheng, K. K.,Chang, A. M.(2003).Palliation of oral mucositis symptoms in pediatric patients treated with cancer chemotherapy.Cancer nursing,26(6),476-84.
7. Dazzi, C.,Cariello, A.,Giovanis, P.,Monti, M.,Vertogen, B.,Leoni, M.,Marangolo, M.(2003).Prophylaxis with GM-CSF mouthwashes does not reduce frequency and duration of severe oral mucositis in patients with solid tumors undergoing high-dose chemotherapy with autologous peripheral blood stem cell transplantation rescue: A double blind, randomized, placebo -controlled study.Annal of Oncology,14(4),559-563.
8. Epstein, J. B.,Vickars, L.,Spinelli, J.,Reece, D.(1992).Efficacy of chlorhexidine and nystatin rinses in prevention of oral complications in leukemia and bone marrow transplantation.Oral Surgery, Oral Medicine, Oral Pathology,73(6),682-629.
9. Ferretti, G. A.,Ash, R. C.,Brown, A. T.,Parr, M. D.,Romond, E. H.,Lillich, T. T.(1988).Control of oral mucositis and candidiasis in marrow transplantation: a prospective, doubleblind trial of chlorhexidine digluconate oral rinse.Bone Marrow Transplant,3(5),483-493.
10. Ferretti, G. A.,Hansen, I. A.,Whittenburg, K.,Brown, A. T.,Lillich, T. T.,Ash, R. C.(1987).Therapeutic use of chlorhexidine in bone marrow transplant patients: case studies.Oral Surgery, Oral Medicine, Oral Pathology,63(6),683-687.
11. Guggenheimer, J.,Mayher, D.,Eghtesad, B.(2005).A survey of dental care protocols among US organ transplant centers.Clinical transplant,19(1),15-8.
12. Hunter, A.,Mahendra, P.,Wilson, K.,Fields, P.,Cook, G.,Peniker, A.,Marcus, R.(2007).A randomized, double-blind, placebocontrolled, multicenter trial of ATL-104, a swallowable Mouthwash, in patients with oral mucositis following peripheral blood stem cell transplantation.Journal of Supportive Oncology,5(4 Suppl 2),52-53.
13. Hunter, A.,Mahendra, P.,Wilson, K.,Fields, P.,Cook, G.,Peniket, A.,Marcus, R.(2009).Treatment of oral mucositis after peripheral blood SCT with ATL-104 mouthwash: results from a randomized, double-blind, placebocontrolled trial.Bone Marrow Transplant,43(7),563-569.
14. Kahn, J.,Delmonico, F.(2004).The consequences of public policy to buy and sell organs for Transplantation.American Journal of Transplantation,4(2),178.
15. Kashiwazaki, H.,Matsushita, T.,Sugita, J.,Shigematsu, A.,Kasashi, K.,Yamazaki, Y.,Ione, N.(2012).Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation.Supportive Care in Cancer,20(2),367-373.
16. Kent, L. T. (2011, Sep, 6). Does L- glutamin cause liver problem? Retrieved from http://www.livestrong.com/article/536927-does-lglutamine-b cause-liver-problems/
17. Oberbaum, M.,Yaniv, I.,Ben-Gal, Y.,Stein, J.,Zvi, N. B.,Freedman, L. S.,Branski, D.(2002).Arandomized, controlled clinical trial of the homeopathic medication Traumeel S in the treatment of chemotherapy-induced stomatitis in children undergoing stem cell transplantation.Biologische Medizin,31(1),25-31.
18. Papas, A. S.,Clark, R. E.,Martuscelli, G.,O'Loughlin, K. T.,Johansen, E.,Miller K. B.(2003).A prospective, randomized trial for the prevention of mucositis in patients undergoing hematopoietic stem cell transplantation.Bone Marrow Transplant,31(8),705-712.
19. Raether, D.,Walker, P. O.,Bostrum, B.,Weisdorf, D.(1989).Effectiveness of oral chlorhexidine for reducing stomatitis in a pediatric bone marrow transplant population.Pediatric Dentistry,11(1),37-42.
20. Soares A. F.,Aquino A. R.,Carvalho C. H.,Nonaka C. F.,Almeida D.,Pinto L. P.(2011).Frequency of oral mucositis and microbiological analysis in children with acute lymphoblastic leukemia treated with 0.12% chlorhexidine gluconate.Brazilian Dental Journal,22(4),312-316.
21. Sugita, J.,Matsushita, T.,Kashiwazaki, H.,Kosugi, M.,Takahashi, S.,Wakasa, K.,Imamura, M.(2012).Efficacy of folinic acid in preventing oral mucositis in allogeneic hematopoietic stem cell transplant patients receiving MTX as prophylaxis for GVHD.Bone Marrow Transplant,47(2),258-264.
22. Valcarcel, D.,Sanz, M. A.,Sureda, A.,Sala, M.,Munoz, L.,Subira, M.,Sierra, J.(2002).Mouth-washings with recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) do not improve grade IIIIV oropharyngeal mucositis (OM) in patients with hematological malignancies undergoing stem cell transplantation. Results of a randomized double- blind placebo- controlled study.Bone Marrow Transplantation,29,783-787.
23. Vokurka, S.,Bystricka, E.,Koza, V.,Scudlova, J.,Pavlicova, V.,Valentova, D.,Misaniova, L.(2005).The comparative effects of povidoneiodine and normal saline mouthwashes on oral mucositis in patients after high-dose chemotherapy and APBSCT--results of a randomized multicentre study.Support Care Cancer,13(7),554-558.
24. Wasko-Grabowska, A.,Rzepecki, P.,Oborska, S.,Barzal, J.,Gawro ski, K.,Mlot, B.,Szczylik, C.(2011).Efficiency of supersaturated calcium phosphate mouth rinse treatment in patients receiving highdose melphalan or BEAM prior to autologous blood stem cell transplantation: a single-center experience.Transplant Proceedings,43(8),3111-3113.
25. Weisdorf, D. J.,Bostrom, B.,Raether, D.,Mattingly, M.,Walker, P.,Pihlstrom, B.,Woods, W.(1989).Oropharyngeal mucositis complicating bone marrow transplantation: prognostic factors and the effect of chlorhexidine mouth rinse.Bone Marrow Transplant,4(1),89-95.
26. Wernerman, J.(2008).Clinical use of glutamine supplementation.The Journal of Nutrition,138(10),2040S-2044S.
27. Worthington, H. V.,Clarkson, J. E.,Bryan, G.,Furness, S.,Glenny, A. M.,Littlewood, A.,McCabe, M. G.(2013).Interventions for preventing oral mucositis for patients with cancer receiving treatment (Review).Cochrane Database of Systematic Reviews,2
28. 台灣實證照護中心(2011)．癌症治療病人口腔黏膜炎之照護指引． 取自http://son.web.ym.edu.tw/front/bin/ptdetail.phtml? Part=TJBCC 二-C&Category=106[Taiwan Joanna Briggs Institute Collaborating Center. Clinical practice guidelines for the patients's mucositis with cancer treatment. Retrieved from http://son.web.ym.edu.tw/front/bin/ptdetail.phtml?Part=TJBCC二-C&Category=106]
29. 陳貞如(2009)。台南=Tainan，國立成功大學醫學院護理系=National Cheng Kung University Medical College, Department of Nursing。

1. 陳榆心,陳雅惠(2022)。一位骨髓增生不良症候群病人接受異體移植之照護經驗。榮總護理，39(2)，146-152。
2. 陳韻安、陳姿廷(2019)。一位初次罹患急性骨髓性白血病青年之護理經驗。長庚護理，30(2)，229-240。
3. 鍾玉珠,徐敏芳,李宥蓁(2019)。照顧一位舌癌病人術後之護理經驗。彰化護理，26(2)，95-106。