居家簡易口腔護理對口鼻咽癌病人口腔黏膜炎的成效－－類實驗研究

Effect of a Simple Home-Based Oral Care Regimen on Oral Mucositis in Patients With Oral Cavity and Nasopharyngeal Cancer: A Quasi-Experimental Study

背景口鼻咽癌病人接受同步放化療期間易出現嚴重口腔黏膜炎，一般護理衛教成效有限。
目的評值居家簡易口腔護理對口腔黏膜炎改善的成效。
方法採雙組類實驗設計，以北部某醫學中心新診斷將接受同步放化療之口鼻咽癌病人為對象，共收實驗組31人、對照組32人。治療期間對照組接受常規照護，實驗組個案則額外提供6–7週雙向互動式居家簡易口腔護理介入措施，成果測量工具為前後兩次牙菌斑檢測及口腔評估指引（oral assessment guide, OAG），OAG測量時間點包含治療前、治療第1–5週、治療結束週與結束後一個月，共8次。資料分析採二因子重複測量共變數分析。
結果在控制相關因子；包含首次／治療結束週OAG分數、營養、年齡、生活習慣、口腔衛生後，損傷期實驗組的口腔黏膜受損速度顯著比對照組緩慢（組別效應F = 11.1, p < .01；組別與時間交互效應F = 3.5, p = .01），但修復期兩組的改善速度無差異（組別及組別與時間效應F = 0.19, p = .67）。
結論／實務應用居家簡易口腔護理對損傷期口腔黏膜炎改善有成效。建議醫護人員在治療結束後，仍應持續加強個案口腔自我照顧的執行力，才能讓效應維持直到口腔黏膜復原。

Background: The majority of patients with oral cavity and nasopharyngeal cancer experience severe oral mucositis during concurrent radiochemotherapy. The effectiveness of routine nursing education remains limited.
Purpose: To evaluate the effect of a simple home-based oral care regimen on oral mucositis.
Methods: A double-group quasi-experimental design was adopted in this study. The participants were all newly diagnosed patients with oral cavity and nasopharyngeal cancer who were scheduled to receive concurrent radiochemotherapy in a northern medical center. A total of 31 patients in the experimental group and 32 patients in the control group were enrolled as participants. The control group received routine care, while the experimental group received an additional six- to seven-week two-way interactive home-based oral care regimen. The measurement tools included a plaque record and oral assessment guide (OAG) implemented twice during the study period. Study data were collected at 8 time points, including before treatment, at 1-5 weeks of treatment, at the end of treatment, and at one-month post-treatment. Data analysis was performed using two-way repeated measures ANCOVA.
Results: After controlling for OAG score, nutrition, age, living habits, and oral hygiene, the development of mucositis was found to be significantly slower in the experimental group than in the control group during the traumatic phase (effect of group: F = 11.1, p < .01; effect of group x time: F = 3.5, p = .01). However, both groups reported a statistically similar rate of improvement during the repair phase (effect of group and group x time: F = 0.19, p = .67).
Conclusions / Implications for Practice: The simple home-based oral care regimen introduced in this study may be used to improve traumatic oral mucositis in patients with oral cavity and nasopharyngeal cancer. It is recommended that even after the completion of radiotherapy, medical staffs should continue to strengthen patients’execution of proper oral care to maintain the positive effect until the mucositis has abated.