化學治療癌症病人口腔黏膜炎發生率調查方案

Mucositis Incidence from Chemotherapy in Oncology Patients

口腔黏膜炎是化學治療中常見的併發症之一，本方案乃依Stetler(1994)研究應用模式，改良並運用口腔評估表調查接受化學治療癌症病人其口腔黏膜炎的發生率，並探討發生口腔黏膜炎的危險因子。研究對象為台北某醫學中心腫瘤病房內首次接受化學治療之癌症病人，分別於病人入院接受化學治療時，收案後一、二、三、四週，作五次追蹤，共收案152人。住院期間每日進行評估與記錄，出院後則以電話或門診繼續追蹤。以特別口腔評估表收集資料，主要統計方法為生命表、及邏輯迴歸分析。重要結果顯示：(1)癌症病人口腔黏膜構造及功能在化療後一星期左右開始發生明顯改變，(2)白血病、胃癌、腎癌、淋巴癌、及乳癌病人其口腔黏膜炎的發生率較高，(3)性別、教育程度及年齡與口腔黏膜炎發生率，則未呈顯著意義，(4)預測使癌症病人產生口腔黏膜炎之抗癌藥為Ara-C與Epirubicin，(5)病人以Normal Saline漱口或Nystatin等預防口腔黏膜炎之藥物的使用率偏低。本方案藉口腔評估表，讓護理人員以一致性的評估標準，瞭解口腔黏膜的改變，根據上述結果期望提供護理人員事先預測、或及時發現異常，立即處理，以降低口腔黏膜炎的發生或惡化。

The administration of many chemotherapy regimens may be complicated by toxicities that result in oral mucositis. An oral membrane assessment checklist involving oral membrane assessment and oral hygiene evaluation was designed for assessing the events of oral mucositis among chemotherapy cancer patients. Stetler research utilization model was used to process research procedures. One hundred and fifty-two patients in 3 oncology wards in a medical center were invited to participate. Nurse researchers utilized the checklist starting from the first day of hospitalization. After being discharged, each patient was followed up with once a week using telephone interviews or outpatient clinic interviews for a whole month. The oral membrane assessment checklist was used as the research instrument. Survival analysis, chi-square test, and logistic regression were used for data analysis using the SPSS 10.0 statistical package. The important findings were that (1) oral mucositis happened mostly after 1-week of therapy; (2) oral mucositis happened more often on leukemia, gastric Ca, kidney Ca, lymphoma, or breast Ca patients; (3) there was no association between oral mucositis and the patients?gender, education and age; (4) administration of Ara-C or Epirubicin was high risk for complication by toxicities to result in oral mucositis; (5) general oral hygiene management of patients appeared poor. The results of this study may help early detection of oral mucositis, manage the discomfort in time, and furthermore decrease the medical cost for chemotherapy cancer patients.