鼻咽癌患者放疗后听力损伤影响因素研究及护理启示

doi:10.3761/j.issn.0254-1769.2026.01.012

摘要/Abstract

摘要：

目的探讨鼻咽癌放疗后听力损伤的发生现状及其影响因素，为听力损伤的防控提供参考。方法采用分层随机抽样法，于2023年10月—2025年3月选取佛山市某三级甲等医院的431例鼻咽癌放疗后患者进行调查，收集患者的疾病资料、放疗后耳部护理行为及并发症等随访资料，并评估听力损伤情况。采用随机森林算法与弹性网络回归，分析并确定影响放疗后听力损伤的主要影响因素。结果鼻咽癌放疗后1~12年内，患者平均听阈为（47.37±21.90）dB，听力损伤总体发生率为73.78%（318/431）。经单因素分析、随机森林算法及弹性网络回归分析结果显示，放疗后年限、顺铂剂量、年龄、放疗后中耳炎首次出现时间、耳部并发症数量及前2年内咽鼓管功能锻炼情况是鼻咽癌放疗后听力损伤的主要影响因素。结论鼻咽癌放疗后听力损伤发生率较高，临床医护人员应在优化治疗方案减少听力损伤的同时，重视放疗后耳部并发症的预防与处理，以延缓听力损伤的发生进程并减轻其严重程度。

关键词: 鼻咽癌, 听力损伤, 随机森林, 影响因素分析, 护理

Abstract:

Objective To investigate the status and risk factors of hearing impairment after radiotherapy in patients with nasopharyngeal carcinoma，in order to provide a reference for the prevention and control of hearing impairment. Methods Using a stratified random sampling method，a follow-up survey was conducted among 431 patients with nasopharyngeal carcinoma who had undergone radiotherapy in a tertiary hospital of Foshan from October 2023 to March 2025. General information，disease-related data，post-radiotherapy ear care behaviors，and complications data from follow-up were collected，and hearing impairment was assessed. The major factors associated with hearing impairment after radiotherapy were analyzed using the random forest algorithm and elastic net regression. Results Within 1~12 years after radiotherapy，the mean hearing threshold of patients was（47.37±21.90）dB，with an overall incidence of hearing impairment of 73.78%（318/431）. Univariate analysis，random forest algorithm，and elastic net regression revealed 6 major risk factors，including the number of years since radiotherapy，cisplatin dosage，age，time to first onset of otitis media after radiotherapy，number of ear-related complications，and eustachian tube function exercises within the first 2 years. Conclusion The incidence of hearing impairment of post-radiotherapy nasopharyngeal cancer is high. Clinical medical staff should optimize treatment plans and pay close attention to the prevention and management of post-radiotherapy ear complications，in order to slow the progression and severity of hearing impairment.

Key words: Nasopharyngeal Carcinoma, Hearing Impairment, Random Forest, Root Caused Analysis, Nursing Care

蒋向玲, 陆慧芬, 虞幼军, 林晓丽, 黄佩铃. 鼻咽癌患者放疗后听力损伤影响因素研究及护理启示[J]. 中华护理杂志, 2026, 61(1): 85-92.

JIANG Xiangling, LU Huifen, YU Youjun, LIN Xiaoli, HUANG Peiling. Influencing factors and nursing implications of hearing impairment in patients with post-radiotherapy nasopharyngeal cancer[J]. Chinese Journal of Nursing, 2026, 61(1): 85-92.

图/表 6

表1 调查对象的一般资料及平均听阈的相关因素分析（n=431）

Table 1 Univariate analysis of general data and mean hearing threshold in patients after radiotherapy for nasopharyngeal carcinoma（n=431）

表2 鼻咽癌放疗后1~12年内听力损伤发生情况（n=431）

Table 2 Analysis of hearing impairment following radiotherapy for nasopharyngeal carcinoma within 1~12 years（n=431）

表3 自变量赋值方式

Table 3 Independent-variable assignment method

表4 鼻咽癌放疗后患者听力损伤随机森林模型参数调优最优范围及最优值

Table 4 Optimal ranges and optimal values of hyperparameter tuning for the random forest model of hearing impairment after radiotherapy for nasopharyngeal carcinoma

图1 随机森林模型的变量重要性评分排序

Figure 1 Ranking of variable importance scores for random forest prediction model

表5 鼻咽癌放疗后患者听力损伤的多因素分析结果（n=431）

Table 5 Multifactorial analysis of hearing impairment after radiotherapy for nasopharyngeal carcinoma（n=431）

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