Otolog kök hücre nakli olan multiple myelom tanılı hastalarda oral mukozitin önlenmesinde kriyoterapinin etkisi
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Dosyalar
Tarih
2019
Yazarlar
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Yayıncı
Ege Üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu araştırmanın amacı, otolog hematopoetik kök hücre nakli öncesinde yüksek doz melfalan hazırlık rejimi alan multiple myelom hastalarında oral kriyoterapi uygulamasının oral mukozit sıklığına, şiddetine ve süresine etkisini incelemektir. Yöntem: Araştırma, Nisan 2018 - Haziran 2019 tarihleri arasında, Ege Üniversitesi Tıp Fakültesi Hastanesi, İzmir Medikal Park Hastanesi ve Sağlık Bilimleri Üniversitesi İzmir Bozyaka Eğitim ve Araştırma Hastanesi'ne bağlı Kemik İliği Nakil Merkezlerinde randomize olmayan gruplarda ön test son test kontrol gruplu yarı deneysel olarak yürütülmüştür. Araştırma dahil olma kriterlerini karşılayan 16 uygulama grubu ve 16 kontrol grubu olmak üzere toplam 32 hasta ile tamamlanmıştır. Veriler toplanırken; Hasta Tanıtım Formu, Dünya Sağlık Örgütü Oral Toksisite Skalası İzlem Formu, Ağız Değerlendirme Rehberi İzlem Formu ve Günlük Hasta İzlem Formu kullanılmıştır. Uygulama grubu hastalarına kemoterapi tedavisinden 5 dakika önce kriyoterapi uygulaması başlanmış ve kemoterapi bittikten 15 dakika sonrasına kadar devam etmiştir (toplam 80 dakika). Uygulama ve kontrol grubundaki hastaların kemoterapi uygulamasından hemen öncesi, kemoterapi sonrası 1. gün, 3. gün, 7. gün, 14. gün ve 21. gün tükürük pH'ı ölçülmüştür. Hastaların ağız mukozası kemoterapi öncesinde, kemoterapi sonrasında 1.-14. günler arasında günlük olarak, 15.-21. günler arasında ise gün aşırı olacak şekilde Dünya Sağlık Örgütü Oral Toksisite Skalası ve Ağız Değerlendirme Rehberi ile değerlendirilmiştir. Verilerin analizinde Shapiro Wilk normallik testi, Pearson Ki-kare Testi, Fisher Ki-kare Testi, Mann Whitney U Testi, Bağımsız Örneklem t-Testi ve Çift Yönlü Varyans Analizi kullanılmıştır. Bulgular: Uygulama grubu hastalarının %43.6'sında, kontrol grubu hastalarının ise %62.5'inde oral mukozit geliştiği ve gruplar arasındaki farkın istatistiksel olarak anlamlı olmadığı saptanmıştır (p>0.05). Uygulama grubundaki hastaların %37.5'inde 1.derece, %6.3'ünde ise 2. derece oral mukozit gelişmiştir. Kontrol grubundaki hastaların %43.8'inde 1.derece, %18.8'inde ise 2. derece oral mukozit gelişmiştir. Hastaların oral mukozit şiddeti arasındaki farkın istatistiksel olarak anlamlı olmadığı belirlenmiştir (p>0.05). Uygulama grubunda oral mukozitin kemoterapi sonrası 5. gün başladığı, 9. gün en üst düzeye ulaştığı ve 18. gün tamamen iyileştiği saptanmıştır. Kontrol grubunda oral mukozitin 2. gün başladığı, 9. gün en üst düzeye ulaştığı ve 16. gün tamamen iyileştiği saptanmıştır. Uygulama grubunda oral mukozitin ortalama devam süresi 5.85±2.19 gün, kontrol grubunda ise 6.80±3.22 gündür. Hastaların OM devam süresi ortalamaları arasındaki farkın istatistiksel olarak anlamlı olmadığı saptanmıştır (p>0.05). Yaş, cinsiyet, beden kitle indeksi ve melfalan dozu gibi bazı risk faktörlerinin oral mukozit gelişimi üzerinde etkili olmadığı belirlenmiştir (p>0.05). Ağız bakım sıklığı ortalamasının uygulama grubu hastalarında (3.30±0.54 defa/gün) kontrol grubu hastalarına (2.64±0.48 defa/gün) göre anlamlı düzeyde yüksek olduğu saptanmıştır (p<0.05). Uygulama ve kontrol grubunda oral mukozit gelişiminin ağız bakım sıklığına göre istatistiksel olarak anlamlı fark göstermediği belirlenmiştir (p>0.05). Sonuç: Bu araştırmadan elde edilen sonuçlara göre, kriyoterapi uygulamasının oral mukozit sıklığını değiştirmediği, oral mukozit şiddetini etkilemediği ve oral mukozit süresini azaltmadığı belirlenmiştir.
Aim: The aim of this study was to investigate the effect of oral cryotherapy on the incidence, severity and duration of OM in multiple myeloma patients who received high-dose melphalan regimen for autologous hematopoietic stem cell transplant. Method: This was a non randomized pretest posttest control group quasi-experimental trial carried out between April 2018 - June 2019 in Bone Marrow Transplantation Unit of Ege University Faculty Hospital, Izmir Medical Park Hospital and Izmir Bozyaka Training and Research Hospital. The study was completed with a total of 32 patients who met the incluison criteria as16 in implementation groups and 16 in control groups. In data collection, Patient Identification Form, WHO Oral Toxicity Scale Follow-up Form, Oral Assessment Guide Follow-up Form and Daily Patient Follow-up Form were used. Cryotherapy was started 5 minutes before the chemotherapy infusion, during the 60 minutes infusion and 15 minutes after completion of the infusion (total 80 minutes). Salivary pH of the patients was measured at days 1 prior to ASCT and 1, 3, 7, 14, and 21 after chemotherapy. The oral mucosa of patients was evaluated before and after chemotherapy to be every day between the first and 14th days and also it was evaluated to be every other day between the 15th-21th days with WHO Oral Toxicity Scale and Oral Assessment Guide. Shapiro Wilk normality test, Pearson chi-square test, Fisher's chi-square test, Mann Whitney U test, Independent Sample t-test and univariate variance test were used to analyze the data. Results: Oral mucositis was present in 43.6% of the implementation group and in 62.5% of the control group but the difference was not statistically significant (p> 0.05). Grade 1 oral mucositis was developed in 37.5% and grade 2 oral mucositis in 6.3% of patients in the implementation group. Grade 1 oral mucositis was developed in 43.8% and grade 2 oral mucositis in 18.8% of patients in the control group. The difference between the patient group was not statistically significant on oral mucositis severity (p> 0.05). In the implementation group, oral mucositis started on the 5th day after chemotherapy, reached the highest level on the 9th day and completely recovered on the 18th day. In the control group, oral mucositis started on the 2nd day, reached the highest level on the 9th day and completely recovered on the 16th day. The mean duration of oral mucositis was 5.85 ± 2.19 days in the implementation group and 6.80 ± 3.22 days in the control group. The difference between the mean duration of OM was not statistically significant among the patients group (p> 0.05). It was determined that some risk factors such as age, sex, body mass index and melphalan dose were not effective on oral mucositis development. The mean frequency of oral care was significantly higher in the implementation group (3.30 ± 0.54 times / day) than in the control group (2.64 ± 0.48 times / day) (p <0.05). There was no statistically significant difference in oral mucositis development between patient groups according to oral care frequency (p> 0.05). Conclusion: According to the results of the study, cryotherapy application has no effect on oral mucositis frequency, oral mucositis severity and oral mucositis duration.
Aim: The aim of this study was to investigate the effect of oral cryotherapy on the incidence, severity and duration of OM in multiple myeloma patients who received high-dose melphalan regimen for autologous hematopoietic stem cell transplant. Method: This was a non randomized pretest posttest control group quasi-experimental trial carried out between April 2018 - June 2019 in Bone Marrow Transplantation Unit of Ege University Faculty Hospital, Izmir Medical Park Hospital and Izmir Bozyaka Training and Research Hospital. The study was completed with a total of 32 patients who met the incluison criteria as16 in implementation groups and 16 in control groups. In data collection, Patient Identification Form, WHO Oral Toxicity Scale Follow-up Form, Oral Assessment Guide Follow-up Form and Daily Patient Follow-up Form were used. Cryotherapy was started 5 minutes before the chemotherapy infusion, during the 60 minutes infusion and 15 minutes after completion of the infusion (total 80 minutes). Salivary pH of the patients was measured at days 1 prior to ASCT and 1, 3, 7, 14, and 21 after chemotherapy. The oral mucosa of patients was evaluated before and after chemotherapy to be every day between the first and 14th days and also it was evaluated to be every other day between the 15th-21th days with WHO Oral Toxicity Scale and Oral Assessment Guide. Shapiro Wilk normality test, Pearson chi-square test, Fisher's chi-square test, Mann Whitney U test, Independent Sample t-test and univariate variance test were used to analyze the data. Results: Oral mucositis was present in 43.6% of the implementation group and in 62.5% of the control group but the difference was not statistically significant (p> 0.05). Grade 1 oral mucositis was developed in 37.5% and grade 2 oral mucositis in 6.3% of patients in the implementation group. Grade 1 oral mucositis was developed in 43.8% and grade 2 oral mucositis in 18.8% of patients in the control group. The difference between the patient group was not statistically significant on oral mucositis severity (p> 0.05). In the implementation group, oral mucositis started on the 5th day after chemotherapy, reached the highest level on the 9th day and completely recovered on the 18th day. In the control group, oral mucositis started on the 2nd day, reached the highest level on the 9th day and completely recovered on the 16th day. The mean duration of oral mucositis was 5.85 ± 2.19 days in the implementation group and 6.80 ± 3.22 days in the control group. The difference between the mean duration of OM was not statistically significant among the patients group (p> 0.05). It was determined that some risk factors such as age, sex, body mass index and melphalan dose were not effective on oral mucositis development. The mean frequency of oral care was significantly higher in the implementation group (3.30 ± 0.54 times / day) than in the control group (2.64 ± 0.48 times / day) (p <0.05). There was no statistically significant difference in oral mucositis development between patient groups according to oral care frequency (p> 0.05). Conclusion: According to the results of the study, cryotherapy application has no effect on oral mucositis frequency, oral mucositis severity and oral mucositis duration.
Açıklama
Anahtar Kelimeler
Hematopoetik Kök Hücre Nakli, Kriyoterapi, Oral Mukozit, Hematopoietic Stem Cell Transplantation, Cryotherapy, Oral Mucositis
