本研究以重覆性生理測量研究方法,來探討鼻咽癌病患於放射治療期間,放射治療導致皮膚反應之功能學和形態學變化之趨勢與相關因素。從96年1月16日至6月8日,為期4個月。以立意取樣,收案數共計19名,平均年齡46歲,男女比為3:1。以放射治療劑量為主軸,每累積大於10Gy時,為測量時間點,由放射治療開始前治治療結束共八次測量。利用RTOG 放射治療皮膚毒性評估準則、皮膚角質水份分析、皮膚色素分析,以及微循環血流分析與自擬自覺症狀量表為本研究工具,以SPSS 15.0版軟體中,GEE統計模式 ( generalized estimating equations method )作計算分析。 研究結果放射性皮膚的生理反應軌跡,皮膚角質層水分含量與放射治療劑量累積呈現顯著負相關(p=.009),自覺皮膚症狀感受、皮膚黑紅色素分析、微循環血流變化呈現正相關。自覺症狀困擾項目上以『發紅』、『皮膚變黑』、『搔癢感』為前三位,自覺症狀困擾以及皮膚生理變化的發生時間,開始於T2,嚴重程度以T6為高峰期。對於皮膚損傷因子以放射治療劑量、相關化學治療、皮膚角質層水份改變、血流變化與病患因應照護方式皆有顯著相關(p<.005)。另外,微循環血流與放射劑量累積時間呈正相關(p=.000,β= .292),但皮膚損傷與血流是呈現負相關(p=.034 β=-.844)。因此,放射治療皮膚反應於微循環血流變化與皮膚嚴重程度應存在重要相關因素,是未來皮膚放射醫療照護研究發展之方向 。
The purpose of this repeated measurement study is measure skin function and morphology weekly during radiotherapy. The 19 patients enrolled this study from Jan 16 to June 8, 2007. Measurement of tools were use Corneometer, Mexameter, and Laser Doppler Image for analysis skin function, RTOG skin reaction scores and the self-reports of patients. Statistics analysis was use software of SPSS 15.0, generalized estimating equations method. This study found water loss of cutonaus with the accumulated dose had negative relative. However, skin color analysis, microcirculation change and self-report of symptom with radiation accumulated dose had positive relative doses. The symptom of "erythema”, “discoloration”, and “skin itching” have significance relative of self-report of symptom. The symptom distress and physical assessment had changed from 20 Gy, the peak stage at over 60Gy. Radiation induced skin damage influence factor had age, radiation doses, received induction chemotherapy, microcirculation change, and skin intervention. Another, this study found microculatin change with increased radiation doses had positive relative(p=.000,β= .292), but if had skin damage, microculatin changed to negative relative (p=.034β= -.844). In conclusion, blood perfusion with radiation therapy induced skin damage had very important machism. Therefore, early detection of these reactions for better care is further in research of radiation- dermatology and radiation nursing.