Karagözoğlu Serife, Filiz Ulusoy Mehlika
Cumhuriyet University School of Nursing, Sivas, Turkey.
J Clin Nurs. 2005 Jul;14(6):754-65. doi: 10.1111/j.1365-2702.2005.01128.x.
The aim of this study is to investigate the effect of oral cryotherapy on the development of chemotherapy-induced mucositis in patients administered combined chemotherapy.
Mucositis has been of interest to scientists for more than 20 years. Unfortunately, this has not resulted in the development of standard procedures for prevention and management. To cope with this side-effect and to prevent opportunistic infections that may emerge during treatment, attempts are taken to provide preventative and comfort measures. In this context, cryotherapy (oral cooling) has become popular as a cheap and readily applicable method in preventing the developing due the rapid infusion of chemotherapy agents, or decreasing its severity.
Study involved 60 patients, 30 of whom were in the study group and 30 in the control group. Ice cubes at a size that can be moved easily in the mouth and whose corners have been smoothed in order that they will not cause irritation in the mouth has been used in oral cryotherapy in the study group. Oral chemotherapy was initiated five minutes before chemotherapy and maintained during venous infusions of etoposide (Vepesid), platinol (Cisplatin), mitomycin (Mitomycin-C) and vinblastin (Velbe) depending on the chemotherapy course.
According to Patient-Judged Mucositis Grading, the rate of mucositis is 36.7% in study group and 90.0% in control group, the difference between two groups being statistically significant (P < 0.05). According to Physician-Judged Mucositis Grading, the rate of mucositis is 10.0% in the study group and 50.0% in the control group, the difference between two groups being statistically significant (P < 0.05). Oral pH values decreased in 90% of the subjects in study group, i.e. mucositis risk was reduced whereas oral pH values remained unchanged or decreased in 86.7% of the subjects in the control group, namely mucositis risk increased. The difference between study and control groups in terms of the change in pH values after chemotherapy was found to be statistically significant (P < 0.05).
Our findings have demonstrated that oral cryotherapy makes an important contribution to the protection of oral health by reducing the mucositis score according to patient- and physician-judged mucositis score and by increasing oral pH values.
Aggressive cancer therapy places patients at greater risk for oral complications and treatment-related consequences. Unfortunately, prevention and/or treatment of such oral sequelae have often become overlooked as priorities of the treatment team. Effective approaches for the prevention or treatment of oral mucositis have not been standardized, and vary considerably among institutions. Prophylactic measures begin with an increased emphasis on improved oral status. Oral cryotherapy, the therapeutic administration of cold, is a prophylactic measure for oral inflammation. The relevance for clinical practice will be to understand the content of mucositis; comprehensive care should focus on the prevention of this complication in the clinical practice.
本研究旨在调查口服冷冻疗法对接受联合化疗患者化疗引起的口腔黏膜炎发展的影响。
20多年来，口腔黏膜炎一直是科学家们关注的问题。不幸的是，这并未导致预防和管理的标准程序的发展。为了应对这种副作用并预防治疗期间可能出现的机会性感染，人们尝试提供预防和舒适措施。在这种情况下，冷冻疗法（口腔冷却）作为一种廉价且易于应用的方法，在预防因化疗药物快速输注而导致的口腔黏膜炎发展或减轻其严重程度方面变得流行起来。
研究涉及60名患者，其中30名在研究组，30名在对照组。研究组在口服冷冻疗法中使用了冰块，冰块大小便于在口腔中轻松移动，其角已被磨平以免在口腔中引起刺激。在化疗前5分钟开始口服化疗，并在依托泊苷（威克瘤）、顺铂（顺氯氨铂）、丝裂霉素（丝裂霉素-C）和长春碱（长春花碱）静脉输注期间根据化疗疗程持续进行。
根据患者判断的口腔黏膜炎分级，研究组口腔黏膜炎发生率为36.7%，对照组为90.0%，两组之间差异具有统计学意义（P<0.05）。根据医生判断的口腔黏膜炎分级，研究组口腔黏膜炎发生率为10.0%，对照组为50.0%，两组之间差异具有统计学意义（P<0.05）。研究组90%的受试者口腔pH值下降，即口腔黏膜炎风险降低，而对照组86.7%的受试者口腔pH值保持不变或下降，即口腔黏膜炎风险增加。化疗后两组pH值变化的差异具有统计学意义（P<0.05）。
我们的研究结果表明，口服冷冻疗法通过根据患者和医生判断的口腔黏膜炎评分降低口腔黏膜炎评分并提高口腔pH值，对保护口腔健康做出了重要贡献。
积极的癌症治疗使患者面临更高的口腔并发症和治疗相关后果的风险。不幸的是，这种口腔后遗症的预防和/或治疗常常被治疗团队忽视。预防或治疗口腔黏膜炎的有效方法尚未标准化，且各机构之间差异很大。预防措施首先要更加重视改善口腔状况。口服冷冻疗法，即冷的治疗性应用，是预防口腔炎症的一种措施。与临床实践的相关性在于了解口腔黏膜炎的内容；综合护理应在临床实践中注重预防这种并发症。
