中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2015年
1期
105-108
,共4页
鼻咽癌%诱导化疗%脑毒性反应%护理
鼻嚥癌%誘導化療%腦毒性反應%護理
비인암%유도화료%뇌독성반응%호리
Nasopharyngeal carcinoma%Neoadjuvant chemotherapy%Encephalopathy%Nursing intervention
目的：探讨鼻咽癌TPF诱导化疗时出现急性脑毒性反应时的护理措施，总结其护理经验。方法：回顾性分析2012年9月-2013年7月3例鼻咽癌患者因综合治疗需要，放疗前给予TPF（多西他赛+顺铂+5-氟尿嘧啶）诱导化疗的临床资料。结果：1例患者化疗结束当天出现脑毒性反应。2例化疗结束后第1天出现脑毒性反应。表现为意识模糊、烦躁不安、答非所问、胡言乱语、大小便失禁等。经过医嘱给予20%甘露醇250 mL加地塞米松5 mg静脉滴注，给予床边心电监护，低流量吸氧，并给予降压及静脉营养对症支持治疗后症状缓解。护理上严密观察病情，做好患者的安全护理，心理疏导，胃肠道护理，骨髓抑制的护理等。3例患者经过对症治疗及护理干预后急性脑毒性反应症状好转并顺利出院。结论：鼻咽癌TPF诱导化疗出现罕见急性脑毒性反应及时给予对症处理及相应的护理干预，是保证治疗顺利完成的关键。
目的：探討鼻嚥癌TPF誘導化療時齣現急性腦毒性反應時的護理措施，總結其護理經驗。方法：迴顧性分析2012年9月-2013年7月3例鼻嚥癌患者因綜閤治療需要，放療前給予TPF（多西他賽+順鉑+5-氟尿嘧啶）誘導化療的臨床資料。結果：1例患者化療結束噹天齣現腦毒性反應。2例化療結束後第1天齣現腦毒性反應。錶現為意識模糊、煩躁不安、答非所問、鬍言亂語、大小便失禁等。經過醫囑給予20%甘露醇250 mL加地塞米鬆5 mg靜脈滴註，給予床邊心電鑑護，低流量吸氧，併給予降壓及靜脈營養對癥支持治療後癥狀緩解。護理上嚴密觀察病情，做好患者的安全護理，心理疏導，胃腸道護理，骨髓抑製的護理等。3例患者經過對癥治療及護理榦預後急性腦毒性反應癥狀好轉併順利齣院。結論：鼻嚥癌TPF誘導化療齣現罕見急性腦毒性反應及時給予對癥處理及相應的護理榦預，是保證治療順利完成的關鍵。
목적：탐토비인암TPF유도화료시출현급성뇌독성반응시적호리조시，총결기호리경험。방법：회고성분석2012년9월-2013년7월3례비인암환자인종합치료수요，방료전급여TPF（다서타새+순박+5-불뇨밀정）유도화료적림상자료。결과：1례환자화료결속당천출현뇌독성반응。2례화료결속후제1천출현뇌독성반응。표현위의식모호、번조불안、답비소문、호언란어、대소편실금등。경과의촉급여20%감로순250 mL가지새미송5 mg정맥적주，급여상변심전감호，저류량흡양，병급여강압급정맥영양대증지지치료후증상완해。호리상엄밀관찰병정，주호환자적안전호리，심리소도，위장도호리，골수억제적호리등。3례환자경과대증치료급호리간예후급성뇌독성반응증상호전병순리출원。결론：비인암TPF유도화료출현한견급성뇌독성반응급시급여대증처리급상응적호리간예，시보증치료순리완성적관건。
Objective: To investigate the nursing intervention for acute encephalopathy induced by TPF neoadjuvant chemotherapy in nasopharyngeal carcinoma, and to sum up the nursing experience for it.Method: We retrospectively analyzed the clinical data of three patients treated with TPF (Docetaxel + Cisplatin + 5-fluorouracil) neoadjuvant chemotherapy, which was part of the combined treatment modality with chemoradiotherapy, from September 2012 to July 2013.Result: Encephalopathy occurred at the ending day of chemotherapy in one patient and at the day after chemotherapy in the other two patients. The three patients suffered from confusion, dysphoria, irrelevant speech, delirium and gatism, etc. Symptoms were relieved after 250 mL 20% mannitol plus 5 mg dexamethasone intravenous infusion, bedside electrocardiographic monitoring, low flow rate oxygen inhalation, antihypertension, intravenous nutrition and supportive care were given, as directed by the doctor. Nursing care of disease observation, safety nursing, psychological counseling, gastrointestinal tract as well as bone marrow suppression was given closely and cautiously meanwhile. After symptomatic treatment and nursing intervention, all the three patients recovered from acute encephalopathy and were discharged safely.Conclusion: Timely symptomatic treatment and corresponding nursing intervention are key points to ensure successful treatment for rare acute encephalopathy induced by TPF neoadjuvant chemotherapy in nasopharyngeal carcinoma.
