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  • 學位論文

接受放射線治療之鼻咽癌患者牙關緊閉、唾液減少與營養狀態之探討

Trismus, Xerostomia, and Nutrition Status on Nasopharyngeal Carcinoma Patients Receiving Radiotherapy

指導教授 : 賴裕和
共同指導教授 : 王成平 陳淑卿(Shu-Ching Chen)

摘要


鼻咽癌為台灣盛行的頭頸部腫瘤之ㄧ,其治療引起的副作用包含牙關緊閉、唾液減少及營養不良等將對病患生活帶來長期影響,隨著存活率的提升,病患同時面臨的生理、心理問題值得更深入的探討。故本研究目的為探討鼻咽癌病患於接受放射線治療後主要生理(牙關緊閉、唾液減少、營養不良)與心理(焦慮、憂鬱)之衝擊,研究採橫斷式相關性設計,以北部某醫學中心耳鼻喉科門診之個案為研究母群體,採立意取樣,經診斷為鼻咽癌且結束積極腫瘤治療介於三個月至五年內之病患納入收案,於民國98年12月30日至99年5月4日,共取得108名個案資料。研究工具以結構式問卷收集病患資料,包括基本資料表、下頜功能不全量表、口乾量表、進食困難量表、迷你營養評估量表、及醫院焦慮量表,並測量病患張口度、無刺激及有刺激之唾液流速。研究結果顯示放射線治療結束時間與牙關緊閉呈顯著相關;放射線治療劑量與口乾嚴重度呈顯著相關;牙關緊閉、口乾、進食困難、營養不良之情形與憂鬱亦呈顯著相關;營養狀態之顯著預測因子包含體重、下頜功能不全嚴重度、憂鬱及身體功能狀態,因此,臨床照護應在治療過程維持病患體重及身體功能狀態,並預防憂鬱及治療後牙關緊閉的發生,以減少治療後病患營養不良的情形;本研究亦提供臨床工作者對此議題有初步了解及實證依據,建議未來針對治療後的副作用發展有效的介入性措施,以改善病患治療後生理及心理之問題。

並列摘要


Nasopharyngeal carcinoma is one of prevalent head and neck cancer in Taiwan. The complications after definitive treatments including trismus, dry mouth, and malnutrition have a long-term impact on patients’ quality of life. With the increase in survival rate, the physiological and psychological issues faced by patients need to be more concerned and explored. The purpose of the study was to explore the impact of radiotherapy on nasopharyngeal carcinoma patients' physical and psychological aspects. The physical aspect includes trismus, dry mouth, and malnutrition and the psychological aspect includes anxiety and depression. A cross-sectional study with purposive sampling was conducted at department of otolaryngology of a medical center in Northern Taiwan. The inclusion criteria for participants were diagnosed with nasopharyngeal carcinoma patients receiving radiotherapy and three mouths to five years after completion of treatments. Between December 2009 and May 2010, the eligible 108 patients were enrolled and assessed by the structured questionnaires including the form of basic information, Mandibular Function Impairment Questionnaire (MFIQ), Xerostomia Questionnaire (XQ), Mini Nutrition Assessment (MNA), Level of Eating Difficulty Scale (LEDS), Hospital Anxiety and Depression Scale (HADS). Maximal interincisor opening and salivary output measured by collecting unstimulated and stimulated whole saliva were also measured in the study. The results showed (1) there was significant correlation between the trismus and the period of time after completion of treatments. (2) there was significant correlation between the dose of the radiation and the severity of dry mouth. (3) there was significant correlation among the severity of trismus, dry mouth, malnutrition, and depression. (4) the predictors of nutrition status were body weight, the severity of mandibular function impairment, depression, and kps. Thus, it should be maintained in the treatments of patients with body weight and kps in clinical practice, and prevent depression and the occurrence of trismus after treatments to reduce malnutrition in patients. Furthermore, our results supply health providers with the knowledge and evidence base. Further researchers should develop the effective intervention for the complications of treatments to enhance patients’ physiology and psychology.

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