鼻咽癌放射治療後皮膚溼性脫屑的處理與分析

　　　　　目的：比較開放性包紮與封閉性包紮應用於鼻咽癌患者皮膚濕性脫屑反應之護理 方案，以評估放射治療引起皮膚傷害癒合的速率，觀察傷口變化之相互關係，了解是否會引 二度感染之機率，進而發展舒適及方便快速的護理方法。材料與方法：100 位接受放射治療 後引起溼性皮膚脫屑反應之鼻咽癌個案進行護理。 臨床上採二種護理方式：（ A ）類固醇 藥膏，（ B ）水膠性（ hydrocolloid ）敷料。而護理過程中乃基於（ 1 ）傷口癒合的時 間，（ 2 ）細菌生長的情形， （ 3 ）傷口的溫度變化，（ 4 ）舒適性，來評估效果之好 壞。結果：100 位個案皮膚傷口皆癒合且無細菌之感染。二種護理方式之傷口溫度變化，皆 隨著皮膚漸進癒合、表皮化而降低，平均下降 1 ℃左右。一天 2 次放射治療與一天放射治 療 1 次等，平均傷口癒合時間：（ 1 ）類固醇藥膏組為 29-42 天，（ 2 ）水膠性敷料組 為 6-13 天。水膠性敷料組有 94 ％的病患感覺舒適，疼痛感完全減輕；而同時類固醇藥膏 組有 22 ％的病人感覺疼痛減輕及舒適。討論：水膠性敷料能完全減輕放射線治療引起的急 性皮膚反應不適及疼痛，縮短療程，增強病人對治療的忍受力及自信心，避免中斷治療之機 率，增加治療之效果；降低感染的危險，可使傷口快速癒合；並且能減少換藥次數，降低護 理工時及經濟成本，提昇醫療服務品質。
　　　　　Purpose：To evaluate the efficacy of gel formula dressing in the wound care of acute skin damage by radiation in nasopharyngeal cancer patients.Materials and Methods： One hundred nasopharyngeal cancer patients developing acute skin reaction at middle neck region due to the effect of irradiation were enrolled into the study and divided into two groups. The first group was applied with （ A ） 0.5% soluble hydrocortisone plus neomycin ointment and the second group with （ B ） DuoDERM （ Bristol-Meyers ） -a gel formula dressing to the skin wound. The end points set for evaluating of skin healing process were （ 1 ）. Bacterial growth, （ 2 ）. Healing time, （ 3 ） .Change in wound temperature and （4）. Pain relief. Results：No local infection was recognized in both groups. Skin temperature lowers 1o C as the skin healing is in progress. The healing time was 29-42 days in the steroid ointment group and 6-13 days in the wet dressing group. Ninety-four percentages of patients in the gel formula dressing group were satisfied with the effect of pain relief, in contrast to only 22 ％ in the hydrocortisone ointment group. Conclusion： Gel gromula dressig did relieve the uncomfortable sensation and shorten the healing time of wet desquamation caused by local irradiation in nasopharyngeal cancer patients.