原 著 放射線皮膚炎に対する保湿クリームの効果 耳鼻科領域の頭頸部照射の患者に保湿クリームを使用して * 1 2 1 2 要旨 2011 1 2013 9 33 0 1 6 16 17 60Gy Key words はじめに 1 70Gy 2 2 QOL 3 4 2014 6 16 2015 4 17 連絡先 359 0042 3 2 Phone 04 2995 1511 Fax 04 2995 0633 E mail hns00332@ndmc.ac.jp 14 29 1 2015
60Gy 5 2 3 5 6 5 7 7 7 1 5 7 8 9 研究目的 研究方法 研究対象者 33 1 2Gy 5 6MeV X 33 2 1 研究期間 2011 1 2013 9 1 方法と内容 ) 研究デザイン ) 患者指導および説明 ) 保湿クリームの選択 ) 保湿クリームの使用方法 1 2 29 1 2015 15
1 10 20 1.5 2g ) データの抽出方法 ( 表 ) CTCAE v 3.0 JCOG/JSCO 2007 3 8 10 11 2 3 データの分析方法 1 Mann Whitney U 2 2 3 Mann Whitney U StatView ver 5.0 5 [ 倫理的配慮 ] [ 用語の定義 ] ) 急性有害事象 ) 乾性落屑 表 皮膚障害の点数化 0 1 2 3 4 5 6 表 対象者の背景 n 16 n 17 p 36 83 66.2 46 86 66.4 U 0.9281 6 9 0.6546 7 6 3 2 50Gy1 60Gy 0 0.5783 60Gy1 60Gy3 66Gy4 66Gy4 70Gy10 70Gy10 11 9 0.5597 6 3 0.3678 U Mann Whitney U 2 p 0.05 16 29 1 2015
表 使用群と未使用群の照射線量ごとの自覚症状と他覚症状 a. 使用群 Gy Gy 1 2 3 4 5 1 2 3 4 5 6 1 60 70 4 24 40 2 70 66 56 8 28 42 52 3 60 66 46 6 18 44 50 64 4 60 70 42 6 32 50 54 5 70 66 60 4 30 48 6 80 66 46 16 34 44 62 7 70 70 64 66 68 2 24 44 62 68 8 70 60 2 8 24 9 60 70 58 68 2 4 30 60 10 60 70 48 2 38 54 11 30 70 64 2 4 58 12 60 70 2 4 50 58 13 60 70 54 8 28 52 68 14 80 70 52 58 6 16 44 62 15 50 70 36 66 10 20 60 64 66 16 60 50 46 48 2 22 32 48 53.0 0.0 51.5 64.5 58.0 5.2 19.3 41.9 57.1 66.0 0.0 12.5 0.0 68.8 25.0 12.5 93.8 100 87.5 87.5 18.8 0.0 b. 未使用群 Gy Gy 1 2 3 4 5 1 2 3 4 5 6 17 60 70 42 52 64 2 8 42 50 64 18 50 66 32 44 54 6 20 30 44 54 19 60 70 52 60 2 4 48 56 20 70 70 44 60 2 32 46 21 70 66 36 40 60 4 8 28 56 22 80 70 46 48 52 2 30 46 50 52 62 23 50 66 32 46 4 10 32 48 24 60 70 30 56 4 40 46 52 56 66 25 80 66 64 10 36 56 64 26 60 60 2 6 40 58 27 70 60 42 44 4 8 32 56 28 70 70 44 56 12 46 56 29 60 60 42 54 14 22 42 50 54 30 60 70 38 46 52 6 8 44 52 31 60 70 18 20 66 4 8 44 56 66 32 50 70 8 6 8 32 66 33 40 70 48 58 68 2 38 46 52 58 Gy 42.0 31.2 44.0 52.6 58.6 5.1 19.5 40.5 53.9 56.4 64.0 23.5 29.4 82.4 41.2 41.2 100 100 88.2 88.2 52.9 11.8 29 1 2015 17
用群未使用群照射線量使無症状かさつきツッパリ感掻痒感痛痒さ痛い 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 10 20 30 40 50 60 70 Gy 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 0 10 20 30 40 50 60 70 Gy 図 使用群と未使用群の照射線量ごとの自覚症状 ) 湿性落屑 ) びらん 結果 対象者の背景 16 17 2011 4 14 1 8 3.1 36 83 66.2 46 86 66.4 70Gy 10 66Gy 4 60Gy 1 3 50Gy 1 11 9 6 3 33 Mann-Whitney U 2 ( 表 ) 18 29 1 2015
用群未使用群照射線量使無症状 乾性落屑 淡い発赤 湿性落屑 発赤 色素沈着 間擦部以外の湿性落屑 中 ~ 高度発赤 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 10 20 30 40 50 60 70 Gy 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 0 10 20 30 40 50 60 70 Gy 図 使用群と未使用群の照射線量ごとの他覚症状 保湿剤使用群と未使用群の皮膚障害の比較 1( 表 図 ) 12.5 53Gy 48Gy 60Gy23.5 42Gy 38Gy 52Gy 0 29.431.2Gy 8Gy 46Gy 68.851.5Gy 36Gy 64Gy 82.4 44Gy 20Gy 64Gy 25 64.5Gy 58Gy 68Gy 41.252.6Gy 44Gy 66Gy 12.558Gy 48Gy 68Gy 41.2 58.6Gy 52Gy 68Gy 4 3 1 1 ( 表 図 )93.8 5.2Gy 2Gy 16Gy100 5.1Gy 2Gy 14Gy 29 1 2015 19
累積点数0 160 140 使用群平均 120 未使用群平均 * * 100 80 * 60 40 *p<0.05 20 0 10 20 30 40 50 60 70 80 照射線量 (Gy) Gy 10 20 30 40 50 60 66 70 3.4 10.0 18.4 29.6 45.1 67.7 83.9 94.5 3.4 11.6 21.4 34.8 56.1 88.4 112.3 127.3 2.4 4.7 6.4 8.3 8.8 9.0 12.0 14.3 1.9 5.4 9.8 15.2 20.8 24.5 27.8 22.9 p 0.9417 0.5618 0.8144 0.4277 0.1211 0.0086 0.0041 0.013 Mann-Whitney U p 0.05 図 照射線量ごとの累積点数 100 19.3Gy 4Gy 38Gy 10019.5Gy 4Gy 46Gy 87.5 41.9Gy 24Gy 60Gy88.2 40.5Gy 28Gy 56Gy 87.5 57.1Gy 48Gy 68Gy88.2 53.9Gy 44Gy 66Gy 18.8 66Gy 64Gy 68Gy 52.956.4Gy 48Gy 66Gy 0 11.864Gy 62Gy 66Gy 50 60 70 1 0 50% 55.5Gy 48Gy 66Gy 50 2 60 2 70 5 3 2 80 3 2 1 2 Mann-Whitney U 60Gy 60Gy 67.7vs.88.4 p=0.0086 66Gy 83.9vs.112.3 p=0.0041 70Gy 94.5vs.127.3 p=0.013 ( 図 ) 60 80 20 29 1 2015
考察 放射線皮膚炎に対する保湿剤の効果 23.5 42Gy 44Gy 29.4 8Gy 46Gy 12.5 18.83 52.99 66Gy 56.4Gy 2.5Gy 1 2 8.9Gy 3 7.3Gy 2 60 80 3 2 脆弱 5 70 60Gy 66Gy 70Gy 29 1 2015 21
放射線皮膚炎に対する看護支援 1 12 1 おわりに 謝 28 辞 結論 文 献 1 2 3 本研究の限界と今後の課題 1 6637 641 2009 2 2011 59 32011 http://www.jshnc.umin.ne.jp 2014 9 26 4 http://search ganjoho.ncc. go.jp/search?q 2014 10 14 5 3408 411 2009 6 2011 62 65 7 6646 649 2009 8 2 1347 8206, 73 75 2000 9 1347 8206, 248 251 2011 10 JCOG / JSCO v 3.0 2007 http://www.jcog.jp/doctor/tool/ctcae.html 2012 08 27 11 143 46 1991 12 314 23 2013 22 29 1 2015
Abstract The Effect of Moisturizing Cream for Radiation Dermatitis Use the Moisturizing Cream for Patients Undergoing Head and Neck Irradiation by Masae Saito 1, Katsumi Hayashi 2 from 1 Nursing Division, National Defense Medical College Hospital 2 Department of Radiology, National Defense Medical College The purpose of this study is to illustrate the value of moisturizing cream in preventing the acute skin side effects induced by radiotherapy and helps nursing care. Thirty three patients with radiotherapy for head and neck cancer from January 2011 to September 2013 were enrolled with their consent. Patients were ineligible if they had undergone tracheotomy or they had not had whole neck field radiotherapy excluding larynx cancer patients. Using the envelope method, we divided patients into those using moisturizing cream (n=16) those not using cream (n=17). The moisturizing cream was applied gently twice a day, after the radiotherapy treatment and before going to bed. During treatment patients underwent daily subjective and objective assessments. We classified these assessments from 0 to 6 step by step and totaled these scores. We analyzed these scores using a statistical method (Mann Whitney U test). As a result, the patients using moisturizing cream displayed a delay in appearance symptoms and significant lower scores subjective and objective assessment than the patients not using moisturizing cream (60Gy: 67.7 vs. 88.4 p<0.01, 66Gy: 83.9 vs. 112.3 p<0.01, 70Gy: 94.5 vs. 127.3 p<0.05). Using moisturizing cream prevents the worsening of radiation dermatitis and relieves the symptoms induced by radiation dermatitis. Key words radiation dermatitis, undergoing head and neck irradiation, skin care, moisturizing cream Address reprint requests to : Masae Saito. Nursing Division, National Defense Medical College Hospital 3 2 Namiki, Tokorozawa-shi, Saitama 359 0042, Japan Phone 04 2995 1511 Fax 04 2995 0633 E mail hns00332@ndmc.ac.jp 29 1 2015 23