探討麩醯胺酸(Glutamine)對癌症病人接受同步化學放射線治療引起口腔黏膜炎之成效Effect of oral glutamine on chemoradiotherapy induced oral mucositis in cancer patients

1149 4 149         DOI：doi.org/10.30131/TWNA_EBHC_Library.DB_2022060003A/Text

2023-03-31 已刊登
綜　整 預防/治療/介入類型

作　　者

黃俐禎*

文章類別

A 類:實證健康照護綜整

問題類型

治療/預防性問題

健康狀況

腫瘤醫學 (Oncology)  

治療/介入措施

其他(Others) -

專長類別

五官、皮膚及其他護理照護

中文關鍵詞

#同步化學放射治療 #麩醯胺酸 #口腔黏膜炎

英文關鍵詞

#chemoradiotherapy # glutamine # oral mucositis

機構名稱

振興醫療財團法人振興醫院

申請單位

護理部

中文摘要
形成臨床提問：
口腔黏膜炎是癌症患者接受化學或放射線治療最常見的併發症，口腔黏膜炎會引起疼痛、吞嚥困難、體重減輕、全身感染風險增加，增加醫療負擔。臨床上使用口內膏或Nystatin粉末作為漱口水為主要治療方式，治療效果不佳，且無絕對有效的治療方式。本研究目的探討麩醯胺酸對癌症病人接受同步化學放射線治療引起口腔黏膜炎成效。
文獻搜尋的方法與分析：
設定關鍵字:Participants:執行同步化學放射治療的癌症病人(Concurrent chemoradiotherapy、Chemoradiotherapy、Radiochemotherapy、Chemoradiotherapy, Adjuvant)、Intervention:麩醯胺酸(Glutamine)、Comparison:安慰劑(Placebo)或無使用麩醯胺酸(No glutamine)、Outcome:降低口腔黏膜炎的嚴重度(Oral mucositis、Mucositis、Stomatitis)。運用布林邏輯(OR及AND)，設定條件：時間為2017至2022年，在PubMed、Cochrane Library、Ovid MEDLINE、華藝中文電子期刊中搜尋，刪除重複及內容不符者，符合文章四篇，最後選定一篇系統性文獻回顧進行評析。
文獻的品質評讀：
評讀文獻為2021年一篇系統性文獻回顧，其證據等級依Oxford Centre for Evidence- Based Medicine 2011 Levels of Evidence的證據等級，評析文章證據等級屬於Level 1，並使用2018年Critical Appraisal Skill Program(CASP)證據等級評估工具針對此篇文獻有效性、重要性及應用性進行評讀結果，評讀結果為10分，屬於高品質文獻。文章研究目的在探討麩醯胺酸是否能預防和緩解癌症病人接受同步化學放射治療之口腔黏膜炎，收案對象為頭頸部鱗狀上皮癌接受放射線治療或同步化學放射治療的病人，統合分析顯示麩醯胺酸能有效預防同步化學放射治療引發嚴重口腔黏膜炎，具有統計學意義。而針對此文獻整理結論出，麩醯胺酸確實能降低口腔黏膜炎嚴重程度。
結果、結論與建議：
綜觀本篇文獻結果顯示接受同步化學放射治療的癌症病人使用麩醯胺酸可減輕口腔黏膜炎的嚴重程度。可建議作為因執行同步化學放射線治療病人合併口腔黏膜炎的輔助措施，降低病人對化學放射線治療所產生的口腔黏膜炎的合併症，進一步改善同步化學放射治療的病患的生活品質。

英文摘要
Ask an answerable question (PICO)：
Oral mucositis is one of the most common adverse reactions of cancer patients undergoing chemotherapy or radiotherapy.Severe oral mucositis is accompanied by pain,dysphagia,weight loss,increased systemic infections and economic impact.Orabase cream or Nystatin oral suspension is a commonly used for oral mucositis.The treatment effect is poor, and there is no absolutely effective treatment.The purpose of this study was to explore the effectiveness of glutamine in evaluating oral mucositis induced by chemoradiotherapy in patients with cancer.
The Method and Analysis of Literature Review：
The key words set were: Participants: Concurrent chemoradiotherapy、Chemoradiotherapy、Radiochemotherapy、Chemoradiotherapy, Adjuvant, Intervention: Glutamine, Comparison:Placebo or No glutamine,and Outcome: Oral mucositis、Mucositis、Stomatitis. We used Bollean logic “OR and AND” to search the database from 2017-2022 in PubMed, Cochrane Library,Ovid MEDLINE,and CEPS.Total four articles were recruited.After studying them, one systematic review study was selected, for critical appraisal of the validity, relevance, and applicability of the research evidence.
Critical Appraisal：
This literature was a Systematic Review (SR) conducted in 2021. The level of evidence is Level 1 according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. We also used the 2018 Critical Appraisal Skill Program (CASP) Levels of Evidence System to evaluate this article's validity, importance, and applicability outcomes; the article obtained a total score of 10, indicating the study to be of high quality. The study aimed to investigate whether glutamine efficacy in preventing and alleviating chemoradiotherapy induced oral mucositis in patients with cancer. The meta-analysis results demonstrate statistical significance of glutamine on the reduction of severe oral mucositis,concluding that glutamine can effectively reduce oral mucositis in patients with cancer.
Results, Conclusions and Recommendations：
Based on the critical appraisal results of evidence-based approach, we can conclude that glutamine could significantly reduced the severity of oral mucositis.We suggest a non-pharmacological intervention in clinical settings to relieve oral mucositis in patients with cancer undergoing chemoradiotherapy and improvement in patient quality of life.