Effect of bundled nursing on recurrent obstructive esophageal cancer treated by photodynamic therapy
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摘要:目的
探讨集束化护理在光动力治疗复发性梗阻型食管癌中的应用效果。
方法对30例复发梗阻型食管癌患者使用光敏剂血卟啉注射液, 24 h后在内镜引导下导入光纤，使用630 nm的激光对肿瘤局部进行照射。分别统计患者进食梗阻缓解程度、体能状况改善情况、体质量指数变化及治疗副反应。采取集束化护理策略，包括术前评估、教育、准备、术后安置、观察、并发症预防以及避光等。
结果患者治疗后食管病灶最窄处中位直径(8.92±0.64) mm, 较治疗前(4.77±0.60) mm增大，卡氏体能状况评分(84.62±6.60)分，较治疗前(77.69±5.99)分提高，体质量指数(18.08±1.60) kg/m2, 较治疗前(17.17±1.66) kg/m2增加, Stooler吞咽困难分级降低。治疗不良反应主要为胸骨后疼痛、发热等。
结论光动力治疗复发性梗阻型食管癌起效快, 副作用小，确保了治疗的顺利开展和患者的安全。
Abstract:ObjectiveTo explore the application of bundled nursing care for recurrent obstructive esophageal cancer treated by photodynamic therapy.
MethodsThirty patients with recurrent obstructive esophageal cancer were administered with photosensitizer hematoporphyrin derivative injection. After 24 hours, an optical fiber was introduced under endoscopic guidance, and 630 nm laser was used to irradiate the tumor locally. The degree of relief in dysphagia, improvement in performance status, changes in body mass index, and treatment-related adverse reactions were recorded. Bundled nursing strategies were implemented, including preoperative assessment, education, preparation, postoperative positioning, observation, prevention of complications, and light protection measures.
ResultsAfter treatment, the median diameter of the narrowest esophageal lesion was increased [(8.92±0.64) mm versus (4.77±0.60) mm], the Karnofsky Performance Status (KPS) score was improved [(77.69±5.99) versus (84.62±6.60)], BMI was increased [(17.17±1.66) kg/m2 versus (18.08±1.60) kg/m2], and the Stooler dysphagia grade was decreased compared with treatment before. The main treatment-related adverse reactions were retrosternal pain and fever.
ConclusionPhotodynamic therapy for recurrent obstructive esophageal cancer has a rapid onset of action and mild adverse reactions, and ensures the smooth implementation of PDT and patients'safety.
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Keywords:
- esophageal malignant neoplasm /
- photodynamic therapy /
- bundled nursing
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表 1 PDT治疗前后相关指标比较(x±s)[n(%)]
指标 治疗前 治疗后 KPS/分 77.69±5.99 84.62±6.60* BMI/(kg/m2) 17.17±1.66 18.08±1.60* 食管病灶最窄处中位直径/mm 4.77±0.60 8.92±0.64* Stooler吞咽困难分级 2级 0 25(83.33) 3级 19(63.33) 5(16.67) 4级 11(36.67) 0 PDT: 光动力疗法; KPS: 卡氏体能状况评分; BMI: 体质量指数。与治疗前比较, *P < 0.05。 
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表 1 PDT治疗前后相关指标比较(x±s)[n(%)]
指标 治疗前 治疗后 KPS/分 77.69±5.99 84.62±6.60* BMI/(kg/m2) 17.17±1.66 18.08±1.60* 食管病灶最窄处中位直径/mm 4.77±0.60 8.92±0.64* Stooler吞咽困难分级 2级 0 25(83.33) 3级 19(63.33) 5(16.67) 4级 11(36.67) 0 PDT: 光动力疗法; KPS: 卡氏体能状况评分; BMI: 体质量指数。与治疗前比较, *P < 0.05。
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