運用蜂蜜與口腔衛教軟體製作口腔衛教方案於頭頸癌相關口腔炎之成效－前驅試驗

The Effect of Using Honey and Oral Hygiene Education Software to Improve Oral Mucositis in Head and Neck Cancer: A Pilot Study

10.6647/CN.202203_29(1).0005

呂宜樺(Yi-Hua Lu)；郭嘉駿(Chia-Chun Kuo)；陳裕文(Yue-Wen Chen)；黃采薇(Tsai-Wei Huang)；施惠芬(Huei-Fen Shih)；任紹菁(Shao-Ching Jen)

蜂蜜 ； 口腔清潔 ； 口腔黏膜炎 ； 頭頸癌 ； 放射線治療 ； Honey ； oral hygiene ； oral mucositis ； head and neck cancer ； radiotherapy

彰化護理

29卷1期（2022 / 03 / 01）

29 - 40

繁體中文

口腔黏膜炎為頭頸癌患者治療過程中非常常見的副作用，易引起細菌感染、口腔黏膜疼痛等，嚴重可影響病患進食、說話意願及癌症療程進度。本研究運用口腔衛教軟體輔助口腔清潔，並合併純蜂蜜的使用，探討其對於口腔黏膜炎的預防與治療之效益。本研究為質量性研究設計，以北部某醫學中心放射腫瘤科門診之頭頸癌病患欲進行放射線治療為收案對象，方案設計應用Brush Monster軟體及純蜂蜜，透過前測、期間追蹤、後測問卷追蹤，輔以LINE官方群組聯絡個案，在病人放射治療期間給予每日兩次配合軟體操作刷牙並配合純蜂蜜一天兩次（起床及睡前），共收集八週，6名個案參與試驗，以質性及量性方法進行分析。共有2位個案完成八週之收集及治療計畫，兩位患者口腔黏膜炎出現時間延後或惡化趨緩，口腔黏膜炎程度控制在WHO一級、疼痛指數控制在2分以下；體重上升、PG-SGA與前測相比後測分數下降，即營養程度改善；後測EQ-5D與前測相比呈現下降，即自覺健康狀態改善、EQ-VAS後測分數比前測高，即受測者心理對於自己的健康評分增加。確實清潔口腔及使用純蜂蜜漱口可緩解或延遲放療導致的口腔黏膜炎，使個案維持正常進食與生活品質。

Oral mucositis is one of the common side effects of head and neck cancer, which can be easily infected and induce pain. It can even affect the patient's appetite, the willingness to talk, and the course of cancer treatment at worst. This article combined the oral hygiene APP with Honey to see the benefit for preventing and treating oral mucositis. Head and neck cancer volunteers were found from outpatients from the radiation therapy division of the northern Taiwan medical center. All cases used Brush Monster APP and Honey and were asked to complete questionnaires during treatment, pre-test, and post-test. Participants were contacted using the LINE APP. A total of 6 cases from Taipei Municipal Wan-fang Hospital were included in this experiment. Treatments were implemented for eight weeks and analyzed with qualitative data analysis. A total of 2 patients completed the eight-week collection and treatment plan. The onset of oral mucositis was delayed in two patients. The degree of oral mucositis is controlled at WHO level 1, and the pain index is controlled below 2 points. The weight of the patient increased. Compared with the pre-test, the PG-SGA score decreased after the test and the nutritional level increased. EQ-5D decreased compared to before baseline and self-awareness health status improved. The EQ-VAS test score was higher than the pre-test level, which means that the mental health score of the patients increased. Maintaining oral hygiene and using pure honey can relieve oral mucositis caused by radiotherapy and avoid exacerbating the damage. Also, helping to intake the patient normally and maintain quality of life.

1. Allen, K. L.,Molan, P. C.,Reid, G. M.(1991).A survey of the antibacterial activity of some New Zealand honeys.The Journal of pharmacy and pharmacology,43(12),817-822.
2. Al-Waili, N. S.,Saloom, K. Y.(1999).Effects of topical honey on post-operative wound infections due to gram positive and gram negative bacteria following caesarean sections and hysterectomies.European journal of medical research,4(3),126-130.
3. Balstad, T. R.,Bye, A.,Jenssen, C. R.,Solheim, T. S.,Thoresen, L.,Sand, K.(2019).Patient interpretation of the Patient-Generated Subjective Global Assessment (PG-SGA) Short Form.Patient preference and adherence,13
4. Biswal, B. M.,Zakaria, A.,Ahmad, N. M.(2003).Topical application of honey in the management of radiation mucositis. A preliminary study.Supportive Care in Cancer,11(4),242-248.
5. Elad, S.,Cheng, K.,Lalla, R. V.,Yarom, N.,Hong, C.,Logan, R. M.,Bowen, J.,Gibson, R.,Saunders, D. P.,Zadik, Y.,Ariyawardana, A.,Correa, M. E.,Ranna, V.,Bossi, P.,Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO)(2020).MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy.Cancer,126(19),4423-4431.
6. Ernsting, C.,Dombrowski, S. U.,Oedekoven, M.,LO, J.,Kanzler, M.,Kuhlmey, A.,Gellert, P.(2017).Using smartphones and health apps to change and manage health behaviors: a population-based survey.Journal of medical Internet research,19(4),e101.
7. Hawker, G. A.,Mian, S.,Kendzerska, T.,French, M.(2011).Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoarthritis pain (icoap).Arthritis care & research,63(S11),S240-S252.
8. Khanjani pour-fard-pachekenari, A.,Rahmani, A.,Ghahramanian, A.,Jafarabadi, M. A.,Onyeka, T. C.,Davoodi, A.(2019).The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: a single-blind clinical trial.Clinical oral investigations,23(4),1811-1821.
9. Liu, T. M.,Luo, Y. W.,Tam, K. W.,Lin, C. C.,Huang, T. W.(2019).Prophylactic and therapeutic effects of honey on radiochemotherapy-induced mucositis: a meta-analysis of randomized controlled trials.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer,27(7),2361-2370.
10. Mallick, S.,Benson, R.,Rath, G. K.(2016).Radiation induced oral mucositis: a review of current literature on prevention and management.European Archives of Oto-Rhino-Laryngology,273(9),2285-2293.
11. Nagi, R.,Patil, D. J.,Rakesh, N.,Jain, S.,Sahu, S.(2018).Natural agents in the management of oral mucositis in cancer patients-systematic review.Journal of oral biology and craniofacial research,8(3),245-254.
12. Rabin, R.,de Charro, F.(2001).EQ-5D: a measure of health status from the EuroQol Group.Annals of medicine,33(5),337-343.
13. Sener, D. K.,Aydin, M.,Cangur, S.,Guven, E.(2019).The effect of oral care with chlorhexidine, vitamin E and honey on mucositis in pediatric intensive care patients: A randomized controlled trial.Journal of pediatric nursing,45,e95-e101.
14. Sonis, S. T.(2004).A biological approach to mucositis.The journal of supportive oncology,2(1),21-36.
15. Vera‐Llonch, M.,Oster, G.,Hagiwara, M.,Sonis, S.(2006).Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma: risk factors and clinical consequences.Cancer: Interdisciplinary International Journal of the American Cancer Society,106(2),329-336.
16. 呂佩霖(2006)。國立臺灣師範大學衛生教育學系。
17. 周繡玲,謝嘉芬,李佳諭,江孟冠,紀雯真(2011)。癌症病人口腔黏膜炎臨床照護指引。瘤護理雜誌，11，61-85。