Procedural Pain Care Inthe Application Of Radiation And Chemotherapy Patients With Nasopharyngeal Carcinoma(NPC)

Objective:To explore the application and effect by procedural pain nursing model in untreated patients with NPC, based on the theory of nursing procedure, make a series of nursing measures of reducing pain reaction and improving sleep of radiation and chemotherapy patients with NPC, So as to improve the quality of life. In order to provide scientific basis for effective nursing measuresin patients with NPC.Methods:This research adopts the semi-random design. From September 2014 to June 2015,collected the 166 cases of radiation and chemotherapy untreated in-patients with NPC in radiotherapy department of the first affiliated hospital of guangxi medical university.83 cases as control group in the first ward,83 cases as experimental group in the second ward. Two groups of patients in gender, age, marital status, occupation, education level, economic status, disease classification, treatment methods, and pain sites were not statistically significant (P>0.05), with comParability. Control group according to the Radiotherapy Department of nasopharyngeal carcinoma patients with routine nursing; The experimental group was taken as the theory of nursing procedure, On the basis of routine nursing care of patients with nasopharyngeal carcinoma had gived procedural pain nursing, Including assessment, diagnosis, planning, implementation and evaluation stages. Before hospitalization,we investigated the two groups of patients with pain, level of depression, sleep quality and quality of life; During radiotherapy, pain in patients with daily assess and record. In different stages of radiotherapy(Radiotherapy 1-10 times,11-20 times,20 times-end) observed in patients with radioactive oral mucosal inflammation, radiation field skin reaction, depression and sleep quality; Holistic evaluated the quality of life of the patients in the hospital during the discharge. Data were analyzed using the SPSS17.0 statistical software, with P <0.05 for the difference was statistically significant.Result:1. Two groups of patients with location of pain, duration and pain score comparison:①Before radiotherapy, the patients in the control group and the experimental group were 38.6% and 45.8% respectively, The experimental group was only 1.2% of the patients with radiation skin pain.28.3% of the patients with NPC within 24 hours of pain duration is more than 12 hours;②In the course of radiotherapy (Radiotherapy 10 time,20 time, end), there is no obvious difference on location of pain in the two group (P>0.05), oropharyngeal and radiation skin pain were commonly. But the duration of pain in the experimental group was lower than that in the control group(P<0.05).③ There were significant differences in pain scores between the two groups at different stages(P<0.05), the pain gradually increased with the time of radiotherapy. The control group degree of pain score rise significantly higher than that of the experimental group, starting from the fourth radiotherapy, pain scores of the two groups were significantly different (P<0.05).2. Comparison of depression score (SDS) between two groups of patients: ① Two groups of 166 patients before hospitalized had a mean value of SDS score (43.89±8.16 points), higher than the domestic norm(41.88±10.57 points), difference was statistically significant(P<0.05);②Comparison of SDS score between two groups of patients before hospitalized, no statistical difference(P> 0.05), two groups showed increased changes, but the experimental group during the radiotherapy SDS score significantly lower than the control group(P<0.01). ③The SDS score of the two groups was statistically difference between 4 different sections(P<0.05).3. Comparison of sleep quality scores(PSQI) between two groups of patients:①patients with NPC before treatment of PSQI score(7.83±4.36 points) compared with domestic norm (4.79±0.12 points) there were significant differences (P<0.01); ②The two groups of patients in the PSQI score of each item and the total score were no difference just was admitted to hospital(P> 0.05).The PSQI score gradually increased with the time of radiotherapy, the experimental group PSQI score rise significantly higher than that of the control group had statistical significance (P<0.05), the sleep quality of the experimental group was better than that of the control group;②Two groups of sleep quality, sleep time, daytime dysfunction, and total score in the four different times by the two comparative differences were statistically significant (P<0.05).4. Comparison of two groups of patients with Radiotherapy adverse reaction (oral mucosal inflammation, radiation skin reaction):①Two groups of patients in the treatment of different stages vary with treatment promote the increasing of adverse reaction;②Experimental group at different times of the treatment of toxic and side effects were lower than the control group remained statistically significant(P<0.05).5. Comparison of quality of life between the two groups:① The quality of life questionnaire(QLQ-C30,QLQ-H&N35) scores were not statistically significant (P>0.05) at admission for two groups of patients with NPC.② After treatment experimental group physical function, role function, emotional function, cognitive function, social function, the general field of health score higher than the control group, in the experimental group,pain, swallowing, feeling, talk, eat social, social contact, mouth, dry mouth, sticky saliva, cough, feeling sick, analgesic drugs and nutritional support symptom score was lower than that in control group(P<0.05).Conclusion:1. In patients with nasopharyngeal carcinoma before and during treatment had different parts and different levels of pain. To take the procedural pain nursing measures can effectively alleviate the pain of patients.2. The psychological depression of patients with nasopharyngeal carcinoma was gradually increased with the treatment, implemented procedural pain nursing mode can reduce the patient’s level of depression, as to improve the treatment compliance of patients.3. patients with nasopharyngeal carcinoma were associated with different levels of sleep disorder during the whole course of treatment. The using of procedural pain nursing mode can significantly improve the sleep quality of patients.4. The incidence of patients with nasopharyngeal carcinoma radiotherapy adverse reaction increased gradually over time. The pain caused by oral mucosal inflammation and radiation dermatitis has seriously affected the patients’ psychological status and quality of life. Implement the procedural pain patients nursing mode can effectively reduce inflammation of the oral mucosa and radiation skin reactions.5. Nasopharyngeal carcinoma patients with depression, radiation side effects can affect the patients quality of life, sleep quality, etc. procedural pain nursing model can effectively improve the quality of life of patients.