鼻咽癌患者放疗后张口困难预防与康复的证据总结

doi:10.3761/j.issn.0254-1769.2024.06.015

摘要/Abstract

摘要：

目的检索、评价并汇总国内外关于鼻咽癌患者放疗后张口困难预防和康复的相关证据，为临床护理提供循证依据。方法检索UpToDate、BMJ Best Practice、Cochrane Library、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、国际指南网、英国国家卫生与临床优化研究所网站、苏格兰校际指南网、美国国立指南库、医脉通指南网、PubMed、Web of Science、EBSCO、CINAHL、Open Grey、中国知网、万方医学网、维普数据库，检索时限为建库至2023年3月，检索文献类型为最佳实践、证据总结、临床决策、指南、系统评价、专家共识和原始研究。筛选检索到的文献并进行质量评价，提取并综合证据，制订推荐级别。结果共纳入18篇文献，包括1篇最佳实践，2篇证据总结，2篇临床决策，3篇指南，6篇系统评价，1篇专家共识和3篇原始研究。从多学科合作、危险因素识别及预防、规范化评估、张口锻炼及康复训练、营养支持、健康教育和随访7个方面总结出24条证据。结论该研究总结的证据可为临床医护人员制订鼻咽癌患者放疗后张口困难预防和康复相关管理方案提供循证依据，证据应用时医护人员需考虑本医院鼻咽癌患者放疗后张口困难的管理现状及个体需求，从而实现预防和康复效果最大化。

关键词: 鼻咽癌, 张口困难, 预防, 康复, 证据总结, 循证护理学

Abstract:

Objective To conduct a systematic search and summary of the relevant evidence regarding the prevention and rehabilitation of radiation-induced trismus in patients with nasopharyngeal carcinoma，and offer recommendations towards the comprehensive prevention and control of trismus in clinical practice. Methods A standardized strategy was employed to search UpToDate，BMJ Best Practice，Cochrane Library，JBI EBP Datebase，GIN，NICE，SIGN，NGC，yimaitong，PubMed，Web of Science，EBSCO，CINAHL，Open Grey，China National Knowledge Infrastructure，Wanfang Medical Network，and VIP database for clinical decisions，guidelines，expert consensuses，systematic reviews，evidence summaries，best practices，and original research. The search time was from the establishment of the databases until March 2023. Results 18 articles were included in total，including 1 best practice，2 evidence summaries，2 clinical decisions，3 guidelines，1 expert consensuses，6 systematic reviews，and 3 original studies. A total of 24 pieces of evidence were summarized in 7 aspects，including multidisciplinary cooperation，identification and prevention of risk factors，standardized assessment，trismus management and functional exercise，nutritional support，health education and follow-up. Conclusion The evidence summarized in this study can provide an evidence-based basis for clinical professionals to develop plans related to the prevention and rehabilitation of trismus in patients with nasopharyngeal carcinoma. When applying the evidence，professionals need to maximize the preventive and rehabilitative effects according to the current status of management of trismus with nasopharyngeal carcinoma in their hospitals and the needs of patients.

Key words: Nasopharyngeal Carcinoma, Trismus, Prevention, Rehabilitation, Evidence Summary, Evidence-Based Nursing

王婷, 陆燕, 曾密, 吴菁菁, 刘彩娟, 曾清清, 曾谷清, 谭颖. 鼻咽癌患者放疗后张口困难预防与康复的证据总结[J]. 中华护理杂志, 2024, 59(6): 744-752.

WANG Ting, LU Yan, ZENG Mi, WU Jingjing, LIU Caijuan, ZENG Qingqing, ZENG Guqing, TAN Ying. Evidence summary for prevention and rehabilitation of radiation-induced trismus in patients with nasopharyngeal carcinoma[J]. Chinese Journal of Nursing, 2024, 59(6): 744-752.

图/表 6

表1 PubMed 检索式

Table 1 Search strategies of PubMed

图1 文献筛选流程图

Figure 1 Flow chart of literature screening

表2 纳入文献的基本特征（n=18）

Table 2 The basic characteristics of the included literature（n=18）

表3 指南的质量评价结果（n=2）

Table 3 The quality evaluation results of the included guidelines（n=2）

表4 系统评价的质量评价结果（n=6）

Table 4 The quality evaluation results of the included systematic reviews （n=6）

表5 鼻咽癌患者放疗后张口困难预防和康复的证据总结

Table 5 Summary of evidence for prevention and rehabilitation of radiation-induced trismus in patients with nasopharyngeal carcinoma

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