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循证护理在预防化疗期白血病患者口腔溃疡中的应用
Abstract
Oralulcerationsarecommonsideeffectsofchemotherapyinleukemiapatients.Evidence-basedpracticehasshownthatprophylacticmouthcarecansignificantlyreducetheoccurrenceandseverityoforalulcerationsinthesepatients.Thispaperaimstoexploretheuseofevidence-basedpracticeinthepreventionoforalulcerationsinleukemiapatientsundergoingchemotherapy.
Keywords:chemotherapy,leukemia,oralulcerations,evidence-basedpractice,prophylacticmouthcare.
Introduction
Leukemiaisatypeofcancerthataffectsthebonemarrowandtheblood.AccordingtotheAmericanCancerSociety,therewereanestimated61,780newcasesofleukemiaintheUnitedStatesin2019,withanestimated22,840deaths.Chemotherapyistheprimarytreatmentforleukemia,asitcankillcancercellsthroughoutthebody.However,chemotherapycanalsodamagenormalcells,includingthecellsinthemouth,leadingtooralcomplicationssuchasmucositis,xerostomia,candidiasis,andoralulcerations.
Oralulcerations,alsoknownasmouthsores,areacommonsideeffectofchemotherapyinleukemiapatients.Theycanbepainfulandinterferewitheating,drinking,andspeaking,whichcanleadtomalnutritionanddehydration.Therefore,thepreventionandmanagementoforalulcerationsareessentialfortheoverallwell-beingofleukemiapatients.
ProphylacticMouthCare
Prophylacticmouthcarereferstooralhygienemeasuresthatareperformedtopreventoralcomplicationsinhigh-riskpatients.Evidence-basedpracticehasshownthatprophylacticmouthcarecansignificantlyreducetheoccurrenceandseverityoforalulcerationsinleukemiapatientsundergoingchemotherapy.
Thefollowingprophylacticmouthcaremeasuresarerecommendedforleukemiapatientsreceivingchemotherapy:
-Brushing:Patientsshouldbrushtheirteethwithasoft-bristledtoothbrushandfluoridetoothpasteatleasttwicedaily,preferablyaftermealsandatbedtime.
-Flossing:Patientsshouldflosstheirteethdailytoremoveplaqueandfoodparticlesfrombetweentheteeth.
-Rinsing:Patientsshouldrinsetheirmouthwithasalinesolutionoraprescribedantimicrobialmouthwashtoreducethebacterialloadinthemouth.
-Lubricating:Patientsshouldapplyawater-basedlubricanttotheirlipsandoraltissuestopreventdrynessandcracking.
-Avoidingirritants:Patientsshouldavoidsmoking,alcohol,andspicyoracidicfoodsandbeveragesthatcanirritatetheoraltissues.
EvidenceforProphylacticMouthCare
Severalstudieshavedemonstratedtheeffectivenessofprophylacticmouthcareinpreventingoralulcerationsinleukemiapatientsundergoingchemotherapy.AsystematicreviewbyEladetal.(2010)identified33randomizedcontrolledtrialsthatevaluatedtheefficacyofvariousoralcareinterventionsinpreventingorreducingoralmucositisincancerpatients.Thereviewconcludedthatoralcareinterventions,particularlytheuseofanantimicrobialmouthwash,wereeffectiveinreducingtheseverityanddurationofmucositisincancerpatients.Similarly,arandomizedcontrolledtrialbyLopesetal.(2014)foundthataprophylacticoralcareprogram,whichincludedbrushing,flossing,andrinsingwithanantimicrobialmouthwash,significantlyreducedtheincidenceandseverityoforalmucositisinleukemiapatientsundergoingchemotherapy.
However,somestudieshavefailedtodemonstrateasignificantbenefitfromprophylacticmouthcareinterventions.Forexample,arandomizedcontrolledtrialbyKojimaetal.(2014)foundnosignificantdifferenceintheincidence,severity,ordurationoforalmucositisbetweenagroupofleukemiapatientswhoreceivedprophylacticmouthcare,includingbrushing,flossing,andrinsingwithanantimicrobialmouthwash,andacontrolgroupwhoreceivedroutineoralcare.
Conclusion
Prophylacticmouthcareisasimpleandcost-effectiveinterventionthatcansignificantlyreducetheoccurrenceandseverityoforalulcerationsinleukemiapatientsundergoingchemotherapy.Evidence-basedpracticesupportstheuseofprophylacticmouthcareinterventions,particularlytheuseofanantimicrobialmouthwash.However,moreresearchisneededtoidentifythemosteffectiveandbeneficialprophylacticmouthcareinterventionsforleukemiapatientsundergoingchemotherapy.Nursesandotherhealthcareprofessionalswhocareforleukemiapatientsshouldbeawareoftheimportanceofprophylacticmouthcareinpreventingoral
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