乳腺癌患者放射性皮炎护理方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2023.21.002

摘要/Abstract

摘要： 目的构建乳腺癌患者放射性皮炎护理方案，并初步探讨其临床应用效果。方法运用证据总结法与专家会议法，构建乳腺癌患者放射性皮炎护理方案。采用便利抽样法，将2022年10月—12月入院的患者设为试验组，按照所构建的护理方案进行干预，将2022年7月—9月入院的患者设为对照组，接受常规护理，干预总时长为5周。5周放疗疗程结束后，比较两组放射性皮炎严重程度、生活质量。结果干预后，试验组急性放射性皮炎反应评估得分为（4.63±2.12）分，低于对照组得分（9.88±2.35）分；急性放射性损伤分级标准为试验组干预后Ⅰ级皮炎22例（91.7%），Ⅱ级皮炎2例（8.33%），对照组干预后Ⅰ级皮炎16例（66.7%），Ⅱ级皮炎8例（33.3%）；试验组干预后乳腺癌生活质量测定量表得分为（102.04±18.20）分，对照组得分为（78.29±13.18）分；差异均具有统计学意义（P<0.001）。结论实施乳腺癌患者放射性皮炎护理方案可以有效降低乳腺癌患者放射性皮炎的严重程度，有效提高乳腺癌患者在放疗期间的生活质量。

关键词: 乳腺肿瘤, 放射性皮炎, 皮肤护理方案

Abstract:

Objective In this research，we constructed a skin care program for radiodermatitis in breast cancer patients and explore its clinical application effect. Methods The skin care program for radiodermatitis of breast cancer patients was constructed by the evidence summary and expert meeting. By the convenient sampling method，the patients admitted from July 2022 to September 2022 were selected as the control group for routine nursing，and the patients admitted from October 2022 to December 2022 were selected as the intervention group. The severity of radiodermatitis and quality of life of patients were compared between the 2 groups. Results The Radiation-Induced Skin Reaction Assesment Scale score of the intervention group was（4.63 ± 2.12） after intervention，which was lower than （9.88 ± 2.35） of the control group. After intervention，ou. Results determined by RTOG showed that 16 patients in the control group had grade Ⅰ dermatitis（66.7%）；8 patients had grade Ⅱ dermatitis（33.3%）；22 patients in the intervention group had grade Ⅰ dermatitis（91.7%），and 2 patients in the intervention group had grade Ⅱ dermatitis（8.33%）. The score of quality of life after intervention was（102.04±18.20） in the intervention group and（78.29±13.18） in the control group. The differences were statistically significant（P<0.001）. Conclusion The skin care program for radiodermatitis can effectively reduce the severity of radiodermatitis of breast cancer patients，and the quality of life of breast cancer patients during radiotherapy can be effectively improved.

Key words: Breast Neoplasms, Radiodermatitis, Skin Care Program

刘璐, 甘佳伟, 姜桐桐, 史铁英. 乳腺癌患者放射性皮炎护理方案的构建及应用研究[J]. 中华护理杂志, 2023, 58(21): 2575-2582.

LIU Lu, GAN Jiawei, JIANG Tongtong, SHI Tieying. Construction and preliminary application of a skin care program in breast cancer patients with radiodermatitis[J]. Chinese Journal of Nursing, 2023, 58(21): 2575-2582.

图/表 4

表1 乳腺癌患者放射性皮炎护理方案

Table 1 Skin care program in breast cancer patients with radiodermatitis

表2 两组一般资料的比较

Table 2 Comparison of basic information between 2 groups of patients

表3 干预后两组患者放射性皮炎反应情况比较（分，$\bar{x}$±s）

Table 3 Comparison of skin damage（RISRAS） between the 2 groups before and after intervention（score，$\bar{x}$±s）

表4 干预前后两组乳腺癌生活质量测定量表总分及各维度得分比较(分,$\bar{x}$±s )

Table 4 Comparison of total scores and scores of eachdimension of quality of life between the 2 groups befoRe and after intervention( score, $\bar{x}$±s )

参考文献 36

[1]	International Agency for Research on Cancer. Global cancer observatory:cancer today[EB/OL]. (2021-02-17)[2023-01-26].https://gco.iarc.fr/tomorrow.
[2]	Castaneda SA, Strasser J. Updates in the treatment of breast cancer with radiotherapy[J]. Surg Oncol Clin N Am, 2017, 26 (3):371-382. DOI PMID
[3]	张金花, 杨碎胜, 司婧. 乳腺癌放疗增敏与机制研究进展[J]. 中华肿瘤防治杂志, 2019, 26(4):277-284.
	Zhang JH, Yang SS, Si J. Research progress on radiosensitization and mechanism in breast cancer[J]. Chin J Cancer Prev Treat, 2019, 26(4):277-284.
[4]	Takala L, Kuusinen TE, Skytt T, et al. Electronic patient-reported outcomes during breast cancer adjuvant radiotherapy[J]. Clin Breast Cancer, 2021, 21(3):e252-e270. DOI PMID
[5]	Gosselin T, Ginex PK, Backler C, et al. ONS guidelines for cancer treatment-related radiodermatitis[J]. Oncol Nurs Forum, 2020, 47(6):654-670. DOI PMID
[6]	Backler C, Bruce SD, Suarez L, et al. Radiodermatitis:clinical summary of the ONS guidelines for cancer treatment-related radiodermatitis[J]. Clin J Oncol Nurs, 2020, 24(6):681-684. DOI URL
[7]	Sherman DW, Walsh SM. Promoting comfort:a clinician guide and evidence-based skin care plan in the prevention and management of radiation dermatitis for patients with breast cancer[J]. Healthcare, 2022, 10(8):1496. DOI URL
[8]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017, 32 (21):1991-1994.
[9]	周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具AGREEⅡ及各领域分值的补充解释及思考[J]. 护理学报, 2018, 25(18):56-58.
	Zhou F, Hao YF, Cong X, et al. Supplementary explanations and reflections on the guideline research and evaluation tool AGREEⅡ and scores in various fields[J]. J Nurs, 2018, 25(18):56-58.
[10]	Joanna Briggs Institute. Joanna Briggs Institute reviews’ manual:2016 edition[EB/OL]. [2023-01-06]. https://www.joannabriggs.org.
[11]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[12]	耿春花. 标准化皮肤护理对乳腺癌放疗后皮损疗效的观察[J]. 齐齐哈尔医学院学报, 2016, 37(21):2715-2717.
	Geng CH. The therapeutic effect of standardized skin nursing intervention on skin lesions caused by radiotherapy for breast cancer[J]. J Qiqihar Med Univ, 2016, 37(21):2715-2717.
[13]	米爱芬, 付英秀, 齐会丽. 认知行为干预对减轻放射性皮炎的效果观察[J]. 中国医药科学, 2013, 3(22):203-204.
	Mi AF, Fu YX, Qi HL. Investigation of the effects of cognitive behavior intervention to mitigate radiodermatitis[J]. Chin Med Pharm, 2013, 3(22):203-204.
[14]	熊沫, 胡娟. 主动性皮肤护理联合临床护理路径对放射性皮炎患者皮损程度、心理状况及疼痛程度的影响[J]. 国际护理学杂志, 2021, 40(8):1476-1479.
	Xiong M, Hu J. Effect of active skin care combined with clinical nursing pathway on skin lesion degree,psychological status and pain degree of patients with radiation dermatitis[J]. Int J Nurs, 2021, 40(8):1476-1479.
[15]	Roy I, Fortin A, Larochelle M. The impact of skin washing with water and soap during breast irradiation:a randomized study[J]. Radiother Oncol, 2001, 58(3):333-339. DOI PMID
[16]	杨维萍, 祝志娟, 徐国英. 预见性护理干预对减轻乳腺癌放疗后皮肤反应的影响[J]. 中国现代医生, 2021, 59(18):159-162.
	Yang WP, Zhu ZJ, Xu GY. The effect of predictive nursing intervention on reducing the skin reaction of breast cancer after radiotherapy[J]. Chin Modern Doctor, 2021, 59(18):159-162.
[17]	王盈, 强万敏, 李静, 等. 皮肤清洁对癌症患者放射性皮炎影响效果的系统评价[J]. 护士进修杂志, 2020, 35(5):426-432.
	Wang Y, Qiang WM, Li J, et al. Skin cleanness for radiation induced skin reaction in cancer patients:a systematic review[J]. J Nurses Train, 2020, 35(5):426-432.
[18]	Yee C, Wang K, Asthana R, et al. Radiation-induced skin toxicity in breast cancer patients:a systematic review of randomized trials[J]. Clin Breast Cancer, 2018, 18(5):e825-e840. DOI URL
[19]	Chan RJ, Webster J, Chung B, et al. Prevention and treatment of acute radiation-induced skin reactions:a systematic review and meta-analysis of randomized controlled trials[J]. BMC Cancer, 2014, 14:53. DOI URL
[20]	Salvo N, Barnes E, Van DJ, et al. Prophylaxis and management of acute radiation-induced skin reactions:a systematic review of the literature[J]. Curr Oncol, 2010, 17(4):94-112. DOI PMID
[21]	王倩, 李振, 张营, 等. 放射性皮炎预防和管理的证据总结[J]. 护理学杂志, 2020, 35(1):83-86.
	Wang Q, Li Z, Zhang Y, et al. Evidence summary for prevention and management of radiation dermatitis[J]. J Nurs Sci, 2020, 35(1):83-86.
[22]	陈紫红, 钟强, 陈永红. 放射性皮炎预防及管理临床实践指南的质量评价与内容分析[J]. 循证护理, 2021, 7(2):151-156,173.
	Chen ZH, Zhong Q, Chen YH. Quality appraisal and content analysis of clinical practice guidelines on prevention and management of radiodermatitis[J]. Chin Evidence-Based Nurs, 2021, 7(2):151-156,173.
[23]	Wong RK, Bensadoum RJ, Boers CB, et al. Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC skin toxicity study group[J]. Support Care Cancer, 2013, 21(10):2933-2948. DOI PMID
[24]	Bolderston A, Lloyd NS, Wong RK, et al. The prevention and management of acute skin reactions related to radiation therapy:a systematic review and practice guideline[J]. Support Care Cancer, 2006, 14(8):802-817. DOI PMID
[25]	The Society & College of Radiographer. The society and college of radiographers practice guideline document[EB/OL]. (2020-04)[2023-01-06]. http://www.sor.org/learning/document-library/The Society and College of Radiographers Practice Guideline Document.
[26]	王黎, 雷洋, 孙兆元, 等. 养老机构失能老人护理服务内容及实施者资质的研究[J]. 中华护理杂志, 2014, 49(11):1285-1289.
	Wang L, Lei Y, Sun ZY, et al. Study on the service contents and staffing qualification for fully-dependent older adults needing both medical and daily living care[J]. Chin J Nurs, 2014, 49(11):1285-1289.
[27]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[28]	郑良建, 张红艳, 袁梦珍, 等. 自黏性软聚硅酮薄膜敷料预防乳腺癌术后急性放射性皮炎的研究[J]. 中国医药指南, 2018, 16(6):11-13.
	Zheng LJ, Zhang HY, Yuan MZ, et al. Effect of mepitel film on prevention radiation-induced skin reactions in postmastectomy[J]. Guide of Chin Med, 2018, 16(6):11-13.
[29]	Noble-Adams R. Radiation-induced reactions 1:an examination of the phenomenon[J]. Br J Nurs, 1999, 8(17):1134-1140. DOI PMID
[30]	Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group(RTOG) and the European Organization for Research and Treatment of Cancer(EORTC)[J]. Int J Radiat Oncol Biol Phys, 1995, 31(5):1341-1346. DOI URL
[31]	Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy Scale:development and validation of the general measure[J]. J Clin Oncol, 1993, 11(3):570-579. DOI PMID
[32]	万崇华, 张冬梅, 汤学良, 等. 乳腺癌患者生命质量测定量表(FACT-B)中文版的修订[J]. 中国心理卫生杂志, 2003, 17(5):298-300.
	Wan CH, Zhang DM, Tang XL, et al. Revision of the Chinese Version of the FACT-B for patients with breast cancer[J]. Chin Mental Health J, 2003, 17(5):298-300.
[33]	Da Silva JGB, Costa DT, Cavalcanti IDL, et al. Quality of life in women with breast cancer treated at a radiotherapy centre in Caruaru,Pernambuco,Brazil[J]. Can Oncol Nurs J, 2022, 32 (2):162-171. DOI URL
[34]	Zhang Q, Wang Y, Yang S, et al. What is the appropriate skin cleaning method for nasopharyngeal cancer radiotherapy patients? A randomized controlled trial[J]. Support Care Cancer, 2022, 30(5):3875-3883. DOI PMID
[35]	Beamer LC, Grant M. Skin-related quality of life among midwestern US community-based women with breast cancer experiencing radiodermatitis[J]. Asia Pac J Oncol Nurs, 2019, 6(1):50-56. DOI URL
[36]	潘宸, 杨林宁, 杨艳. 乳腺癌患者健康信息需求的研究进展[J]. 中华护理杂志, 2022, 57(20):2547-2554. DOI
	Pan C, Yang LN, Yang Y. Research progress on health information needs of breast cancer patients[J]. Chin J Nurs, 2022, 57(20):2547-2554. DOI