鼻咽癌TPF方案诱导化疗出现急性脑毒性反应处理及护理.docVIP

鼻咽癌TPF方案诱导化疗出现急性脑毒性反应处理及护理 　　【摘要】 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。 　　【关键词】 鼻咽癌； 诱导化疗； 脑毒性反应； 护理 　　【Abstract】 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. 　　【Key words】 Nasopharyngeal c