CAJ | 학술논문

目的：观察调强适形放射治疗（IMRT）联合西妥昔单抗治疗中晚期鼻咽癌的临床疗效。方法选择鼻咽癌晚期患者40例，随机分为治疗组与对照组，各20例。对照组患者接受IMRT+化学治疗（简称化疗）方案，放射治疗(简称放疗)同时予以顺铂治疗；治疗组患者在对照组基础上加用西妥昔单抗治疗。两组患者均给予适当的综合护理干预。治疗结束后评估两组患者临床疗效；治疗期间每周复查血常规，每2个周期复查肝肾功能、血电解质及心电图；观察与治疗相关的不良反应；随访3年，观察患者肿瘤复发率及死亡率。结果治疗组患者总缓解率为50.00%，明显高于对照组的30.00%（ P ﹤0.05）；两组患者的CD4+，CD8+，CD4+/CD8+比较，差异无统计学意义（ P﹥0.05）；随访3年，第1年两组患者生存率无统计学差异（ P ﹥0.05），第2，3年治疗组生存率均明显高于对照组（ P﹤0.05）；两组患者皮炎、消化道反应、超敏反应的发生率比较，差异无统计学意义（ P﹥0.05），但口腔黏膜反应治疗组明显高于对照组（ P﹤0.05）。结论 IMRT联合西妥昔单抗治疗中晚期鼻咽癌疗效好，远期生存率更高，对免疫功能的影响与传统方案相似，不良反应可控，患者耐受性较好。适当的护理干预能保障治疗的顺利进行，提高患者的生活质量，值得临床推广。
목적：관찰조강괄형방사치료（IMRT）연합서타석단항치료중만기비인암적림상료효。방법선택비인암만기환자40례，수궤분위치료조여대조조，각20례。대조조환자접수IMRT+화학치료（간칭화료）방안，방사치료(간칭방료)동시여이순박치료；치료조환자재대조조기출상가용서타석단항치료。량조환자균급여괄당적종합호리간예。치료결속후평고량조환자림상료효；치료기간매주복사혈상규，매2개주기복사간신공능、혈전해질급심전도；관찰여치료상관적불량반응；수방3년，관찰환자종류복발솔급사망솔。결과치료조환자총완해솔위50.00%，명현고우대조조적30.00%（ P ﹤0.05）；량조환자적CD4+，CD8+，CD4+/CD8+비교，차이무통계학의의（ P﹥0.05）；수방3년，제1년량조환자생존솔무통계학차이（ P ﹥0.05），제2，3년치료조생존솔균명현고우대조조（ P﹤0.05）；량조환자피염、소화도반응、초민반응적발생솔비교，차이무통계학의의（ P﹥0.05），단구강점막반응치료조명현고우대조조（ P﹤0.05）。결론 IMRT연합서타석단항치료중만기비인암료효호，원기생존솔경고，대면역공능적영향여전통방안상사，불량반응가공，환자내수성교호。괄당적호리간예능보장치료적순리진행，제고환자적생활질량，치득림상추엄。
Objective To observe the efficiency of intensity-modulated radiation therapy (IMRT) combimed with cetuximab in treating advanced nasopharyngeal carcinoma. Methods 40 cases of advanced nasopharyngeal carcinoma were randomly divided into the treatment group and the control group,20 cases in each group. The control group received IMRT plus chemotherapy,meanwhile receiving radiother-apy with cisplatin;on the basis of the control group,the treatment group received cetuximab. The two groups were given comprehensive nursing intervention. The clinical efficiencies of the two groups after the end of treatment were assessed;during treatment,the weekly re-view of blood was conducted,and the periodic examination of the liver and kidney function,blood electrolytes and electrocardiogram (ECG) was conducted biweekly;the adverse reactions related to the treatment was observed. The data of tumor recurrence and death was observed during 3 years of follow-up. Results The total remission rate in the treatment group was 50. 00%,which was higher than 30. 00% in the control group( P ﹤ 0. 05);the CD4+,CD8+,CD4/CD8+ of the two groups had no statistical difference( P ﹥ 0. 05);after 3 years of follow-up,the survival rate of the two groups showed no difference in the first year( P ﹥ 0. 05),the survival rate of the treatment group in the 2,3 years was significantly higher than that of the control group( P ﹤ 0. 05);the incidence rate of adverse reactions such as dermatitis,gastrointestinal and hypersensitivity had no statistical significance( P ﹥ 0. 05),but the oral mucosa reaction in the treatment group was significantly higher than that of the control group( P ﹤ 0. 05). Conclusion The clinical efficacy of IMRT combined with cetuximab in treating advanced nasopharyngeal carcinoma is good,the long-term recurrence rate is low,the adverse re-actions can be controlled,the patients are well tolerated,and appropriate nursing intervention can ensure the smooth progress of the treatment,improve the quality of life of patients,thus is worthy of clinical promotion.