頭頸部放射線療法之癌症病人施行口腔護理方案成效之探討

　　　　　口腔黏膜改變是接受頸部放射線療法病人最常見的問題，其發生率高達50%～78%。病人常因治療後口腔粘膜發炎、潰瘍、口乾、吞嚥及咀嚼疼痛、味覺改變、及體重下降等症狀發生，嚴重影響治療期間的生活品質。護理人員若能於治療期間實施病人一套完整有效的口腔護理方案，將可改善病人口腔不適的情形發生。 本研究目的即探討施行口腔護理方案，對接受頭頸部放射線療法病人口腔粘膜構造、口腔功能、白血球計數、及體重改變的影響。 本研究採準實驗設計法依治療先後順序選取50位接受頭頸部放射線療法之癌症病人，分派實驗組和對照組各25人。當兩組病人之「口腔粘膜改變評量表」達14分時，實驗組提供衛教手冊並教導每日執行口腔護理方案；而對照組只接受常規護理衛教。於放射線治療期間每週評估兩組病人之口腔粘膜構造、口腔功能；以及治療前及每隔一週 各評估白血球計數及體重改變情形。 研究結果顯示，執行口腔護理方案後。 （一）實驗組病人的口腔粘膜構造改變程度較對照組小。 （二）實驗組病人的口腔功能，除味覺無顯著改善外，其他項目如：唾液分泌、吞嚥、咀嚼、及說話等改變程度較對照組為小。 （三）兩組病人在白血球計數的改變程度未達顯著差異。（四）實驗組病人體重改變較對照組為小。 由此可見，口腔護理方案的實施，能有效減輕放射線治療病人的口腔粘膜構造、口腔功能、及體重改變的程度，故可提供臨床護理人員一套明確的護理指引。
　　　　　The alteration in oral membrane of cancer patients is a common health problem which caused by head and neck. radiotherapy. Approximately 50~78% patients demonstrated the symptoms of: mycosis’s, oral ulcer, xerostoma, painful of swell-owing and chewing, taste change, and body weight loss. These symptoms extremely affect their quality of life. The comprehensive and effective oral care protocol needs to be implemented to prevent or relieve the oral discomfort. The purpose of this Study were to explore the effects of oral care protocol on oral membrane structure, oral function, WBC and body weight of cancer patients undergone head and neck radiotherapy. A quasi experiment study was designed and 50 head and neck cancer patients were consecultively assigned to experimental group (n=25) and control group (n=25). The oral care protocol was demonstrated and implemented on experimental group when the oral score was more than 14. Each experimental patient practiced oral care protocol daily at home. The control group received routine care. The oral membrane structure and oral function were assessed weekly and WBC and body weight were measured every other week during the radiotherapy. The results showed as follows: (1) Experimental group presented lower altercation in oral mucous structure then control group. (2) Experimental group demonstrated lower altercation in oral function then control group. (3) There was no significant difference in WBC change between two groups. (4) Experimental group had lower body weight change than control group. The results of this study suggested that the oral care protocol can be an effective nursing intervention in clinical setting.