降低頭頸癌接受放射線治療病患之口腔黏膜炎Grade II、Grade III的發生率

Reducing the Incidence of Grade II and III Mucositis Patients with Head and Neck Cancer Undergoing Radiotherapy

10.29494/LN.201806_19(2).0008

曾秀如(Hsiu-Ju Tseng)；曾翠怡(Tsuei-Yi Tseng)；吳靜儀(Ching-Yi Wu)；黃美玲(Mei-Ling Huang)；陳姝年(Chu-Nien Chen)

放射線治療 ； 口腔黏膜炎 ； 口腔護理 ； radiotherapy ； oral mucositis ； oral mucus care

領導護理

19卷2期（2018 / 06 / 01）

91 - 105

繁體中文

頭頸癌病患接受放射線治療時，當劑量大於5,000cGy約第28天發生口腔黏膜炎高達100%，嚴重的口腔黏膜炎不僅使病患產生劇烈疼痛，營養攝取不足，甚至會中斷癌症治療計畫。專案旨在降低頭頸癌行放射線治療第28天病患口腔黏膜炎Grade II、Grade III的發生率。2014年頭頸癌接受放射線治療之病患共186位，口腔黏膜炎Grade II及Grade III佔59.1%，主因爲病患及家屬的衛教理解能力不足、護理師對口腔黏膜等級認知不一致、外傭照顧者無法有效溝通、病患經濟差不願購置用具；解決辦法有舉辦病患及家屬團體衛教、口腔護理在職教育、製作口腔護理包、放射線治療之口腔護理影片及印尼版衛教單張。對策實施後護理師執行口腔護理正確率由56.8%升至97.3%，口腔黏膜炎Grade II 36.0%降至26.7%、Grade III 23.1%降至13.3%，顯示能降低口腔黏膜炎Grade II、Grade III發生率，進而提升病患接受治療意願及增加生活品質。

Oral Mucositis is a common side effect of radiotherapy for head and neck cancer with a 100% incidence rate with a total radiation dosage greater 5000cGy on Day 28 of the treatment. The aim of the proposal was to decrease the incidence of Grade II and III mucositis. There were 186 patients with head and neck cancer undergoing radiotherapy in 2014 with a 59.1% incidence rate of Grade II and III mucositis, which were mainly results of inadequate care of oral hygiene in patients by their caregivers, different assessments of mucositis by disparate nurses, ineffective communication with foreign household workers and no proper equipment for relieving mucositis. These problems were solved by holding group educational sessions for patients and their caregivers, enhancement of clinical practice of nurses to ensure a consistent grading of mucositis, creating oral hygiene leaflets in different languages and providing oral care packages. Through the methods as mentioned above, the grading of mucositis by nurses increased from a consistency of 56.8% to 97.3% and also a decrease in the severity of mucositis (Grade II: 36.0% down to 26.7%; Grade III: 23.1% down to 13.3%). The methods listed helped patients foster a willingness to continue treatment and increase their quality of life. Concurrently, the improvements also help nursing staff provide holistic evaluations and a higher quality of nursing care of oral mucus problems during radiotherapy.

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