低温手足套联合“五防”教育在预防紫杉类药物相关周围神经病变中的应用

徐令婕; 饶维维; 柳静; 韩越越; 杨燕

doi:10.16766/j.cnki.issn.1674-4152.003568

低温手足套联合“五防”教育在预防紫杉类药物相关周围神经病变中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003568

蚌埠医科大学第一附属医院肿瘤内科，安徽蚌埠 233004

基金项目:

安徽省高校优秀青年人才支持项目 gxyq2022042

蚌埠医学院自然科学重点项目 2021byzd105

详细信息

通讯作者:
徐令婕，E-mail: xulj2019@163.com

中图分类号: R473.73 R979.1
计量
- 文章访问数: 107
- HTML全文浏览量: 71
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-12
- 网络出版日期: 2024-07-22

The application of low-temperature hand and foot covers combined with "five precautions" education in the prevention of taxane-related peripheral neuropathy

Department of Oncology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨非药物干预在预防紫杉类药物相关周围神经病变中的应用效果。方法选取蚌埠医科大学第一附属医院肿瘤内科住院且接受紫杉类药物化疗的252例患者作为研究对象，将2022年7—12月的125例患者作为对照组，2023年1—6月的127例患者作为观察组。对照组采用肿瘤内科化疗护理常规，观察组采用低温手足套联合“五防”教育。比较2组患者周围神经病变的症状体验、患者日常生活质量和居家安全不良事件情况。结果观察组手指/手麻木、脚趾/脚麻木、脚趾/脚刺痛、手指/手或脚趾/脚不舒服、肌肉或关节痛的发生率、症状严重程度及症状困扰程度均低于对照组(P＜0.05)；观察组影响握持小物品[38.58%(49/127)]、睡眠[46.46%(59/127)]、写字[55.91%(71/127)]、做平时的家务[62.99%(80/127)]的率均低于对照组[52.00%(65/125)、61.60%(77/125)、69.60%(87/125)、82.40%(103/125), P＜0.05]；观察组居家跌倒[5.51%(7/127)]和磕碰[7.87%(10/127)]发生率低于对照组[16.00%(20/125)和18.40%(23/125), P＜0.05]。结论采用低温手足套联合“五防”教育可有效减少紫杉类药物相关周围神经病变发生，改善患者症状体验和日常生活质量，防止居家安全不良事件的发生。
- 低温手足套 /
- “五防”教育 /
- 紫杉类药物 /
- 周围神经病变
Abstract: Objective To explore the application effect of non-pharmacological intervention in the prevention of taxane-related peripheral neuropathy. Methods A total of 252 patients who were hospitalized in the Department of Oncology of the First Affiliated Hospital of Bengbu Medical University and received taxane-based chemotherapy were selected as the study subjects. Among them, 125 patients from July to December 2022 were taken as the control group, and 127 patients from January to June 2023 were taken as the observation group. Patients in the control group received routine chemotherapy care from the medical oncology department, while patients in the observation group received low-temperature hand and foot covers combined with "five precautions" education. The peripheral neuropathy including symptom experience, quality of daily life, and adverse home safety events between the two groups were compared. Results The incidence, severity, and degree of symptom distress of finger/hand numbness, toe/foot numbness, toe/foot tingling, finger/hand or toe/foot discomfort, and muscle or joint pain in the observation group were lower than those in the control group (P < 0.05). The observation group had lower rates of holding small items [38.58% (49/127)], sleeping [46.46% (59/127)], writing [55.91% (71/127)], and doing household chores [62.99% (80/127)] compared to the control group [52.00% (65/125), 61.60% (77/125), 69.60% (87/125), 82.40% (103/125), P < 0.05]. The incidence of home falls (5.51%, 7/127) and collisions (7.87%, 10/127) in the observation group were lower than those in the control group [16.00% (20/125) and 18.40% (23/125), P < 0.05]. Conclusion The use of low-temperature hand and foot covers in combination with "five precautions" education can effectively reduce the occurrence of taxane-related peripheral neuropathy, improve patients' symptom experience and quality of daily life, and reduce the occurrence of adverse home safety events.
- Low temperature hand and foot covers /
- "Five precautions" education /
- Taxanes /
- Peripheral neuropathy

HTML全文

表 1 2组恶性肿瘤患者一般资料比较

Table 1. Comparison of general information between two groups of malignant tumor patients

项目	对照组 (n=125)	观察组 (n=127)	统计量	P值
性别(例)			0.137^a	0.711
男性	60	58
女性	65	69
年龄(x±s，岁)	59.95±14.08	60.80±14.15	0.478^b	0.633
吸烟(例)			0.127^a	0.721
是	79	83
否	46	44
饮酒(例)			0.387^a	0.534
是	65	71
否	60	56
高血压/糖尿病史(例)			0.396^a	0.529
是	41	37
否	84	90
药物分类(例)			1.494^a	0.684
紫杉醇	64	71
多西他赛	34	29
白蛋白紫杉醇	25	23
紫杉醇脂质体	2	4
化疗次数(例)			0.779^c	0.436
1~3次	86	93
4~8次	21	18
9~12次	14	14
＞12次	4	2
肿瘤分期(例)			0.078^c	0.938
Ⅰ期	14	16
Ⅱ期	13	9
Ⅲ期	39	42
Ⅳ期	59	60
注：^a为χ²值，^b为t值，^c为Z值。

下载: 导出CSV

表 2 2组恶性肿瘤患者CIPN症状体验比较

Table 2. Comparison of CIPN symptom experience between two groups of malignant tumor patients

症状	发生例数[例(%)]		χ²值	P值	发生频次[M(P₂₅, P₇₅), 次]		Z值	P值
症状	对照组(n=125)	观察组(n=127)	χ²值	P值	对照组(n=125)	观察组(n=127)	Z值	P值
手指/手麻木	90(72.00)	45(35.43)	33.867	< 0.001	1.00(0.00, 1.00)	0.00(0.00, 2.00)	1.883	0.06
脚趾/脚麻木	80(64.00)	34(26.77)	22.906	< 0.001	2.00(0.00, 4.00)	0.00(0.00, 1.00)	6.613	< 0.001
手指/手刺痛	15(12.00)	12(9.45)	0.429	0.513	0.00(0.00, 1.00)	0.00(0.00, 0.00)	1.096	0.273
脚趾/脚刺痛	18(14.40)	8(6.30)	4.468	0.035	3.00(0.00, 5.00)	0.00(0.00, 3.00)	6.159	< 0.001
手指/手或脚趾/脚不舒服	92(73.60)	45(35.43)	36.989	< 0.001	4.00(0.00, 5.50)	0.00(0.00, 3.00)	6.443	< 0.001
对冷温度敏感	36(28.80)	28(22.05)	1.516	0.218	0.00(0.00, 0.00)	0.00(0.00, 0.00)	1.558	0.119
肌肉或关节痛	61(48.80)	40(31.50)	7.854	0.005	1.00(0.00, 1.50)	0.00(0.00, 2.00)	1.865	0.062
胳膊或腿无力	48(38.40)	40(31.50)	1.321	0.250	1.00(0.00, 4.50)	0.00(0.00, 2.00)	3.695	< 0.001
很难保持身体平衡	25(20.00)	18(14.17)	1.511	0.219	0.00(0.00, 0.00)	0.00(0.00, 0.00)	1.330	0.184

症状	严重程度[M(P₂₅, P₇₅), 分]		Z值	P值	困扰程度[M(P₂₅, P₇₅), 分]		Z值	P值
症状	对照组(n=125)	观察组(n=127)	Z值	P值	对照组(n=125)	观察组(n=127)	Z值	P值
手指/手麻木	4.00(0.00, 6.00)	0.00(0.00, 4.00)	5.151	< 0.001	2.00(0.00, 4.00)	0.00(0.00, 3.00)	3.931	< 0.001
脚趾/脚麻木	2.00(0.00, 6.00)	0.00(0.00, 2.00)	5.189	< 0.001	1.00(0.00, 2.00)	0.00(0.00, 1.00)	4.127	< 0.001
手指/手刺痛	0.00(0.00, 0.00)	0.00(0.00, 0.00)	0.576	0.564	0.00(0.00, 0.00)	0.00(0.00, 0.00)	0.567	0.571
脚趾/脚刺痛	0.00(0.00, 0.00)	0.00(0.00, 0.00)	2.256	0.024	0.00(0.00, 0.00)	0.00(0.00, 0.00)	2.197	0.028
手指/手或脚趾/脚不舒服	4.00(0.00, 8.00)	0.00(0.00, 4.00)	5.672	< 0.001	1.00(0.00, 2.00)	0.00(0.00, 2.00)	4.416	< 0.001
对冷温度敏感	0.00(0.00, 3.00)	0.00(0.00, 0.00)	1.286	0.198	0.00(0.00, 2.00)	0.00(0.00, 0.00)	1.215	0.224
肌肉或关节痛	0.00(0.00, 4.00)	0.00(0.00, 2.00)	3.045	0.002	0.00(0.00, 2.00)	0.00(0.00, 1.00)	2.991	0.003
胳膊或腿无力	0.00(0.00, 3.00)	0.00(0.00, 2.00)	1.152	0.249	0.00(0.00, 2.00)	0.00(0.00, 2.00)	1.218	0.223
很难保持身体平衡	0.00(0.00, 0.00)	0.00(0.00, 0.00)	1.134	0.257	0.00(0.00, 0.00)	0.00(0.00, 0.00)	1.265	0.206

下载: 导出CSV

表 3 2组恶性肿瘤患者日常生活质量影响得分比较

Table 3. Comparison of quality of daily life impact scores between two groups of malignant tumor patients

项目	影响例数[例(%)]		χ²值	P值	生活质量影响得分[M(P₂₅, P₇₅), 分]		Z值	P值
项目	对照组(n=125)	观察组(n=127)	χ²值	P值	对照组(n=125)	观察组(n=127)	Z值	P值
穿衣服(扣纽扣、拉拉链)	27(21.60)	20(15.75)	1.422	0.233	0.00(0.00, 0.00)	0.00(0.00, 0.00)	0.992	0.321
走路	95(76.00)	90(70.87)	0.851	0.356	7.00(2.00, 8.00)	3.00(0.00, 7.00)	3.234	0.001
捡起小物品	59(47.20)	45(35.43)	3.599	0.058	0.00(0.00, 4.00)	0.00(0.00, 3.00)	1.859	0.063
握持小物品	65(52.00)	49(38.58)	4.578	0.032	1.00(0.00, 5.00)	0.00(0.00, 6.00)	1.467	0.142
开车	80(64.00)	74(58.27)	0.871	0.351	6.00(0.00, 7.00)	1.00(0.00, 4.00)	3.198	0.001
工作	95(76.00)	89(70.08)	3.491	0.062	6.00(1.00, 8.00)	4.00(0.00, 8.00)	1.541	0.123
参加业余活动	101(80.80)	96(75.59)	1.002	0.317	6.00(4.00, 8.00)	5.00(1.00, 8.00)	1.807	0.071
锻炼	84(67.20)	72(56.69)	2.949	0.086	4.00(0.00, 7.00)	1.00(0.00, 6.50)	1.585	0.113
睡眠	77(61.60)	59(46.46)	5.815	0.016	5.00(0.00, 8.00)	0.00(0.00, 7.00)	2.866	0.004
性生活	103(82.40)	98(77.17)	1.069	0.301	7.00(4.00, 8.00)	5.00(1.50, 8.00)	1.495	0.135
与他人相处	85(68.00)	79(62.20)	0.931	0.335	3.00(0.00, 6.00)	2.00(0.00, 6.00)	0.953	0.341
写字	87(69.60)	71(55.91)	5.052	0.025	5.00(0.00, 7.00)	1.00(0.00, 5.00)	3.202	0.001
做平时的家务	103(82.40)	80(62.99)	11.934	0.001	5.00(2.00, 8.00)	2.00(0.00, 7.00)	2.826	0.005
享受生活	115(92.00)	109(85.83)	2.431	0.119	6.00(3.00, 8.00)	4.00(2.00, 7.00)	2.978	0.003

下载: 导出CSV

表 4 2组恶性肿瘤患者居家安全不良事件发生情况比较[例(%)]

Table 4. Comparison of adverse home safety events between two groups of malignant tumor patients[cases (%)]

组别	例数	跌倒	磕碰	烫伤	冻伤	锐器伤
对照组	125	20(16.00)	23(18.40)	0	0	0
观察组	127	7(5.51)	10(7.87)	0	0	0
χ²值		7.244	6.133
P值		0.007	0.013

下载: 导出CSV

参考文献(15)

[1]	马飞, 刘明生, 王佳妮, 等. 紫杉类药物相关周围神经病变规范化管理专家共识[J]. 中国医学前沿杂志(电子版), 2020, 12(3): 41-51. https://www.cnki.com.cn/Article/CJFDTOTAL-YXQY202003007.htm MA F, LIU M S, WANG J N, et al. Expert consensus on standardized management of taxane-related peripheral neuropathy[J]. Chinese Journal of the Frontiers of Medical Science(Electronic Version), 2020, 12(3): 41-51. https://www.cnki.com.cn/Article/CJFDTOTAL-YXQY202003007.htm
[2]	NICOLAE R, UCCELLINI A, SIDEROV J, et al. Taxane induced neuropathy: how serious is this problem for patients with early breast cancer?[J]. Asia Pac J Clin Oncol, 2023, 19(2): e118-e127.
[3]	任丽萍, 王永芳, 焦俊博, 等. 癌症患者化疗致周围神经病变及相关因素对生活质量的影响[J]. 中华护理教育, 2020, 17(12): 1129-1133. doi: 10.3761/j.issn.1672-9234.2020.12.015 REN L P, WANG Y F, JIAO J B, et al. A pathway analysis of impact of chemotherapy induced peripheral neuropathy and its predictors on quality of life among cancer patients[J]. Chinese Journal of Nursing Education, 2020, 17(12): 1129-1133. doi: 10.3761/j.issn.1672-9234.2020.12.015
[4]	COOLBRANDT A, VANCOILLE K, DEJAEGER E, et al. Preventing taxane-related peripheral neuropathy, pain and nail toxicity: a prospective self-controlled trial comparing hilotherapy with frozen gloves in early breast cancer[J]. Breast Cancer Res Treat, 2022, 192(2): 293-301. doi: 10.1007/s10549-021-06477-0
[5]	CHAN A, ELSAYED A, NG D Q, et al. A global survey on the utilization of cryotherapy and compression therapy for the prevention of chemotherapy-induced peripheral neuropathy[J]. Support Care Cancer, 2022, 30(12): 10001-10007. doi: 10.1007/s00520-022-07383-x
[6]	LOPRINZI CHARLES L, CHRISTINA L, JONATHAN B, et al. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO Guideline Update[J]. J Clin Oncol, 2020, 38(28): 3325-3348. doi: 10.1200/JCO.20.01399
[7]	王悦, 白燕妮, 郑玉杰, 等. 化疗所致周围神经病变评估工具的汉化及信效度检测[J]. 解放军护理杂志, 2018, 35(5): 14-18. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL201805006.htm WANG Y, BAI Y N, ZHENG Y J, et al. Reliability and Validity of Chinese Version of Chemotherapy-induced Peripheral Neuropathy Assessment Tool[J]. Nursing journal of chinese people's liberation army, 2018, 35(5): 14-18. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL201805006.htm
[8]	BURGESS J, FERDOUSI M, GOSAL D, et al. Chemotherapy-induced peripheral neuropathy: epidemiology, pathomechanisms and treatment[J]. Oncol Ther, 2021, 9(2): 385-450. doi: 10.1007/s40487-021-00168-y
[9]	JIA J, GUO Y, SUNDAR R, et al. Cryotherapy for prevention of taxane induced peripheral neuropathy: a meta-analysis[J]. Front Oncol, 2021, 11: 781-812.
[10]	ENGVALL K, GRÉEN H, FREDRIKSON M, et al. Impact of persistent peripheral neuropathy on health-related quality of life among early-stage breast cancer survivors: a population-based cross-sectional study[J]. Breast Cancer Res Treat, 2022, 195(3): 379-391. doi: 10.1007/s10549-022-06670-9
[11]	NOVAK M, MILIČEVIĆ J, BIŠOF V. Impact of chemotherapy-induced peripheral neuropathy on the quality of life in cancer patients[J]. Acta Clin Croat, 2022, 61(1): 52-61.
[12]	RATTANAKRONG N, SIRIPHORN A, BOONYONG S. Incidence and risk factors associated with falls among women with breast cancer during taxane-based chemotherapy[J]. Support Care Cancer, 2022, 30(9): 7499-7508. doi: 10.1007/s00520-022-07181-5
[13]	YAMAMOTO S, FUJIKAWA N, ASANO K, et al. Assessment of fall-related self-efficacy: characteristics that influence the perception of patients with chemotherapy-induced peripheral neuropathy[J]. Asia Pac J Oncol Nurs, 2020, 7(2): 190-195. doi: 10.4103/apjon.apjon_54_19
[14]	KANG G E, MURPHY T K, KUNIK M E, et al. The detrimental association between fear of falling and motor performance in older cancer patients with chemotherapy-induced peripheral neuropathy[J]. Gait Posture, 2021, 88: 161-166. doi: 10.1016/j.gaitpost.2021.05.022
[15]	WINBERG T B, HEDGE E T, PETERSON S D, et al. Influence of intermittent pneumatic compression on foot sensation and balance control in chemotherapy-induced peripheral neuropathy patients[J]. Clin Biomech (Bristol, Avon), 2021, 90: 105512. DOI: 10.1016/j.clinbiomech.2021.105512.