护理学报 ›› 2020, Vol. 27 ›› Issue (6): 23-28.doi: 10.16460/j.issn1008-9969.2020.06.023
冷冻疗法降低化疗患者口腔黏膜炎发生的Meta分析
裴露斯, 杨雪梅, 翟田田, 赵亚芸, 冯兰棱, 张迁
- 兰州大学护理学院,甘肃 兰州 730030
摘要： 目的 通过Meta分析评价冷冻疗法降低化疗患者口腔黏膜炎发生率的效果。方法 检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science、The Cochrane Library、EMbase、Medline数据库,获取冷冻疗法作为干预措施对化疗患者口腔黏膜炎实施的随机对照试验,检索时限为建库至2019年6月,分别由2名研究人员独立根据纳排标准进行筛选文献,采用RevMan5.3软件进行Meta分析。结果 共纳入10篇随机对照试验,761例患者。Meta分析结果显示,与对照组相比,试验组冷冻疗法能有效地降低化疗引起的口腔黏膜炎发生率[RR=0.62,95%CI（0.53,0.72）,P<0.01],减轻口腔黏膜炎严重程度[RR=0.37,95%CI（0.27,0.51）,P<0.01],缓解疼痛以及减少止痛剂的使用[RR=0.13,95%CI（0.03,0.52）,P<0.01]。在减少全肠外营养支持的需要上差异无统计学意义（P=0.23）。结论 冷冻疗法可以明显降低化疗引起的口腔黏膜炎发生率,减轻口腔黏膜炎严重程度,缓解疼痛以及减少止痛剂的使用,但在减少全肠外营养支持的需要方面缺乏证据支持,需要高质量的研究进行验证。
中图分类号:
- R473.73
| [1] De Sanctis V, Bossi P, Sanguineti G, et al.Mucositis in Head and Neck Cancer Patients Treated with Radiotherapy and Systemic Therapies: Literature Review and Consensus Statements[J]. Crit Rev Oncol Hemat, 2016,100(4):147-166. DOI:10.1016/j.critrevonc.2016.01.010. [2] Karagözoglu S, Filiz Ulusoy M.Chemotherapy: The Effect of Oral Cryotherapy on the Development of Mucositis[J]. J Clin Nurs, 2005,14(6):754-765. DOI:10.1111/j.1365-2702.2005.01128.x. [3] Bhatt V, Vendrell N, Nau K, et al.Implementation of a Standardized Protocol for Prevention and Management of Oral Mucositis in Patients Undergoing Hematopoietic Cell Transplantation[J]. J Oncol Pharm Pract,2010,16(11):195-204. DOI:10.1177/1078155209348721. [4] Vokurka S, Chvojkova I, Svoboda T, et al.The Impact of Oral Cryotherapy and Oral and Gastrointestinal Mucositis after Autologous Stem Cell Transplantation[J]. Eur J Oncol Nurs, 2014, 18(2):228-229. DOI:10.1016/j.ejon.2013.11.001. [5] Katranc1 N, Ovayolu N, Ovayolu O, et al. Evaluation of the Effect of Cryotherapy in Preventing Oral Mucositis Associated with Chemotherapy-a Randomized Controlled Trial[J]. Eur J Oncol Nurs, 2012, 16(4):339-344. DOI:10.1016/j.ejon.2011.07.008. [6] Batlle M, Morgades M, Vives S, et al.Usefulness and Safety of Oral Cryotherapy in the Prevention of Oral Mucositis after Conditioning Regimens with High-dose Melphalan for Autologous Stem Cell Transplantation for Lymphoma and Myeloma[J]. Eur J Haematol, 2014, 93(6):487-491. DOI:10.1111/ejh.12386. [7] Sato A, Saisho-Hattori T, Koizumi Y, et al.Prophylaxis of Mucosal Toxicity By Oral Propantheline and Cryotherapy in Children with Malignancies Undergoing Myeloablative Chemo-radiotherapy[J]. Tohoku J Exp Med, 2006, 210(4):315-320. DOI:10.1620/tjem.210.315. [8] Ohbayashi Y, Imataki O, Ohnishi H, et al.Multivariate Analysis of Factors Influencing Oral Mucositis in Allogeneic Hematopoietic Stem Cell Transplantation[J]. Ann Hematol, 2008, 87(10):837-845. DOI:10.1007/s00277-008-0508-6. [9] Mori T, Aisa Y, Yamazaki R, et al.Cryotherapy for the Prevention of High-dose Melphalan-induced Oral Mucositis[J]. Bone Marrow Transpl, 2006, 38(9):637-638. DOI:10.1038/sj.bmt.1705494. [10] Dumontet C, Sonnet A, Bastion Y, et al.Prevention of High Dose L-PAM-induced Mucositis by Cryotherapy[J]. Bone Marrow Transplant,1994,14(3):492-494. DOI:10.1007/BF02303818. [11] Aisa Y, Mori T, Kudo M, et al.Oral Cryotherapy for the Prevention of High-dose Melphalan-induced Stomatitis in Allogeneic Hematopoietic Stem Cell Transplant Recipients[J]. Support Care Cancer, 2005, 13(4):266-269. DOI:10.1007/s00520-004-0726-y. [12] Baydar M, Dikilitas M, Sevinc A, et al.Prevention of Oral Mucositis Due to 5-Fluorouracil Treatment with Oral Cryotherapy[J]. J Natl Med Assoc, 2005, 97(8):1161-1164. DOI:10.1002/ijc.26320. [13] Worthington HV, Clarkson JE, Bryan G, et al. Interventions for Preventing Oral Mucositis for Patients with Cancer Receiving Treatment[J]. Cochrane Db Syst Rev,2011(4):CD000978. DOI:10.1002/14651858. [14] Kanuga S.Cryotherapy and Keratinocyte Growth Factor May be Beneficial in Preventing Oral Mucositis in Patients with Cancer, and Sucralfate is Effective in Reducing its Severity[J]. J Am Dent Assoc, 2013, 144(8):928-929. DOI:10.14219/jada.archive.2013.0211. [15] Wang L, Gu Z, Zhai R, et al.Efficacy of Oral Cryotherapy on Oral Mucositis Prevention in Patients with Hematological Malignancies Undergoing Hematopoietic Stem Cell Transplantation: A Meta-analysis of Randomized Controlled Trials[J]. PLoS One, 2015, 10(5):e0128763. DOI:10.1371/journal.pone.0128763. [16] Higgins JP, Green S.Cochrane Handbook for Systematic Reviews of Interventions,Version 5.1.0[M]. London:Wiley-Blackwell,2011:102-108. [17] 胡雁. 循证护理学[M].北京:人民卫生出版社,2012:573-575. [18] Salvador P, Azusano C, Wang L, et al.A Pilot Randomized Controlled Trial of an Oral Care Intervention to Reduce Mucositis Severity in Stem Cell Transplant Patients[J]. J Pain Symptom Manag, 2012, 44(1):64-73. DOI:10.1016/j.jpainsymman.2011.08.012. [19] Lilleby K, Garcia P, Gooley T, et al.A Prospective, Randomized Study of Cryotherapy During Administration of High-dose Melphalan to Decrease the Severity and Duration of Oral Mucositis in Patients with Multiple Myeloma Undergoing Autologous Peripheral Blood Stem Cell Transplantation[J].Bone Marrow Transpl,2006,37(11):1031-1035. DOI:10.1038/sj.bmt.1705384. [20] Marchesi F, Tendas A, Giannarelli D, et al.Cryotherapy Reduces Oral Mucositis and Febrile Episodes in Myeloma Patients Treated with High-dose Melphalan and Autologous Stem Cell Transplant: A Prospective, Randomized Study[J]. Bone Marrow Transpl, 2017, 52(1):154-156. DOI:10.1038/bmt.2016.207. [21] Sorensen JB, Skovsgaard T, Bork E, et al.Double-blind, Placebo-controlled, Randomized Study of Chlorhexidine Prophylaxis for 5-Fluorouracil-based Chemotherapy-induced Oral Mucositis with Nonblinded Randomized Comparison to Oral Cooling (Cryotherapy) in Gastrointestinal Malignancies[J]. Cancer, 2008, 112(7):1600-1606. DOI:10.1002/cncr.23328. [22] Katranci N, Ovayolu N, Ovayolu O, et al.Evaluation of the Effect of Cryotherapy in Preventing Oral Mucositis Associated with Chemotherapy-A Randomized Controlled Trial[J]. Eur J Oncol Nurs, 2012, 16(4):339-344. DOI:10.1016/j.ejon.2011.07.008. [23] Mahood DJ, Dose AM, Loprinzi CL, et al.Inhibition of Fluorouracil-induced Stomatitis by Oral Cryotherapy[J]. J Clin Oncol, 1991, 9(3):449-452. DOI:10.1200/JCO.1991.9.3.499. [24] Cascinu S, Fedeli A, Fedeli S L, et al.Oral Cooling (Cryotherapy), an Effective Treatment for the Prevention of 5-Fluorouracil-induced Stomatitis[J]. Eur J Cancer B Oral Oncol, 1994, 30(4):234-236. DOI:10.1016/0964-1955(94)90003-5. [25] Svanberg A, Öhrn K, Birgegård G.Oral Cryotherapy Reduces Mucositis and Improves Nutrition-A Randomised Controlled Trial[J]. J Clin Nurs, 2010, 19(15-16):2146-2151. DOI:10.1111/j.1365-2702.2010.03255.x. [26] Papadeas E, Naxakis S, Riga M, et al.Prevention of 5-Fluorouracil-related Stomatitis by Oral Cryotherapy: A Randomized Controlled Study[J]. Eur J Oncol Nurs, 2007, 11(1):60-65. DOI:10.1016/j.ejon.2006.05.002. [27] Idayu RMN, Lei PC, Wan WZI, et al.Oral Cryotherapy: Prevention of Oral Mucositis and Pain Among Patients with Colorectal Cancer Undergoing Chemotherapy[J]. Clin J Oncol Nurs, 2018, 22(5):555-560.DOI:10.1188/18.CJON.555-560. [28] Askarifar M, Lakdizaji S, Ramzi M, et al.The Effects of Oral Cryotherapy on Chemotherapy-induced Oral Mucositis in Patients Undergoing Autologous Transplantation of Blood Stem Cells: A Clinical Trial[J]. Iran Red Crescent Me, 2016, 18(4):e24775. DOI:10.5812/ircmj.24775. [29] Shin N, Kang Y.The Effects of Oral Cryotherapy on Oral Mucositis, Reactive Oxygen Series, Inflammatory Cytokines, and Oral Comfort in Gynecologic Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Trial[J]. J Korean Acad Nurs, 2019,49(2):149-160.DOI:10.4040/jkan.2019.49.2.149. [30] Heydari A, Sharifi H, Salek R.Effect of Oral Cryotherapy on Combination Chemotherapy-induced Oral Mucositis: A Randomized Clinical Trial[J]. Middle East J Cancer, 2012, 3(2-3):55-64. [31] 赵凤军,王银萍,赵秀荣,等.生理盐水漱口预防急性白血病化疗后真菌性口腔炎的研究[J].护理研究, 2005,19(11B):2370-2371. DOI:10.3969/j.issn.1009-6493.2005.26.010. [32] 周琳琳,苏少晨,翟田田,等.蜂蜜预防放化疗导致的口腔黏膜炎及相关疼痛的系统评价[J].中国护理管理,2019,19(5):693-700.DOI:10.3969/j.issn.1672-1756.2019.05.011. [33] Peterson DE, Öhrn K, Bowen J, et al.Systematic Review of Oral Cryotherapy for Management of Oral Mucositis Caused by Cancer Therapy[J]. Support Care Cancer, 2013, 21(1):327-332. DOI:10.1007/s00520-012-1562-0. [34] 王悦,付菊芳,白燕妮,等.癌症患者对化疗导致周围神经病变症状体验及应对方式的质性研究[J].护理学报,2016,23(22):9-13. DOI:10.16460/j.issn1008-9969.2016.22.009. [35] 赵炳媛,刘凤,姜桂春,等.肿瘤患者阿片类药物相关性便秘严重程度现状及影响因素分析[J].护理学报,2019,26(11):9-14. DOI:10.16460/j.issn1008-9969.2019.11.009. |
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