[Abstract] Objective To investigate the paclitaxel adjuvant chemotherapy in the treatment of cervical cancer, ovarian cancer care and effect.
Papers Category:Medicine Papers
- Clinical Medicine Papers
Post Time:2013/4/16 8:48:00
Methods A retrospective analysis from January 2008 to December 2009 in our hospital gynecological applications paclitaxel-based combination chemotherapy in cervical cancer, 26 cases of ovarian cancer patients clinical data results in 25 patients to complete the full chemotherapy, four cases of allergic reactions, including one case more serious alternative chemotherapy, 5 patients had mild gastrointestinal side effects, 1 case of intravenous administration of the drug solution leakage 17 patients with varying degrees of hair loss. conclusion paclitaxel chemotherapy in the treatment of cervical cancer, ovarian cancer during chemotherapy nurse to fully grasp the characteristics of toxicity of chemotherapy drugs, to strengthen drug toxicity observed, do various preventive measures, at the same time do a good job psychological care to prevent and reduce the toxicity, to ensure the smooth progress of chemotherapy, in order to achieve the desired therapeutic effect.
[Keywords] paclitaxel gynecological malignancies adjuvant chemotherapy nursing papers to write high incidence of gynecological malignancy, cervical cancer, ovarian cancer, and tumors of the female reproductive system, two surgery and adjuvant chemotherapy cervical cancer, ovarian cancer treatment. Taxol anticancer efficacy as a plant-based, has been widely used in clinical, but its immediate allergic toxicity consequences are serious risks to clinical care This article reviews 2008 January to December 2009 in our hospital gynecological applications paclitaxel-based combination chemotherapy in the treatment of the cervix, the clinical data of 26 cases of ovarian cancer patients, to explore the methods of care and effect are as follows.
1 Materials and Methods
1.1 Clinical data
Cervical cancer in this group, 26 cases of ovarian cancer patients, aged 25 to 64 years old, 39 years old on average, seven cases of cervical cancer are squamous cell carcinoma, four cases for preoperative induction chemotherapy, five cases of rows hysterectomy pelvic lymph nodes clear after adjuvant chemotherapy, 19 cases of ovarian cancer, postoperative adjuvant chemotherapy for ovarian cancer.
1.2 chemotherapy administration method
Acute allergic reactions in ethyl generation for the prevention of paclitaxel thinner polyoxyethylene castor oil, the medication must be preprocessed, namely chemotherapy former 12h and 6h oral dexamethasone 20mg injection before infusion 30min, diphenhydramine 50mg intramuscular injection and Ranitidine 50mg intravenous paclitaxel each time the amount of 180 to 210 mg every 3 to 4 weeks. cervical cancer preoperative induction 1 week, 1 to 2 courses.
25 patients to complete the full chemotherapy, two cases of allergic reactions, including one case more serious alternative chemotherapy, 4 patients had mild gastrointestinal side effects, 1 case of intravenous administration of the drug solution leakage, 16 patients had different the degree of hair loss.
3.1 chemotherapy before care ① before chemotherapy, asked in detail about whether the drug allergy history and history of heart disease.
(2) before paclitaxel pretreatment, is the key to prevent allergic reactions the nurse must strictly prescribed time to dexamethasone, diphenhydramine, ranitidine ready kindly electrocardiographic monitoring and other drugs. ③ before treatment, oxygen device, dexamethasone injection, epinephrine hydrochloride, saline and emergency medicine.
3.2 psychological care
For younger patients or initial chemotherapy patients, patients with difficult to accept the condition, easy to doubt, do not want to face reality, depression, fear, and that cancer is a death, incurable, some patients with a passive attitude toward treatment of such patients nurses should patiently explain domestic and international applications paclitaxel chemotherapy treatment effect, cited scientific data and successful cases in addition to its concerns, and enhance confidence in the treatment of patients its initiative with the chemotherapy treatment and care for patients, patients with recurrent or repeated chemotherapy because of poor efficacy on lack of confidence in treatment, should close and fully communicate well with patients and their families to prevent negative pessimism. introduce drug efficacy, route of administration and possible adverse reactions and treatment for all patients, so that patients have enough mental preparation with treatment. considerate of patients, to understand the patient's mood and aspirations.
3.3 Prevention and Care of allergic reactions
Paclitaxel allergic reactions belong to the type I allergic reaction, mild type I hypersensitivity reactions occurred in 40% of severe incidence of about 2% to .80% of cases within 10 min after the paclitaxel drug, the most common symptoms of facial flushing, skin erythema, urticaria, angioedema, serious allergic reactions manifested as bronchospasm difficulty breathing, rapid pulse, hypotension or even shock, serious consequences must attach great importance to prevent allergic reactions, you should take the following measures: ① 12 h before chemotherapy and 6h oral dexamethasone 20 mg, injection before infusion for 30 min, 50 mg of diphenhydramine 50mg intramuscular injection and ranitidine infusion. ② baseline prepare oxygen, ECG monitoring device, and emergency medicine. ③ infusion paclitaxel, use a dedicated non-PVC infusion set, the terminal is equipped with a 0.22m filter, prevented paclitaxel dilution, the fine particles into the patient's body. ④ infusion of paclitaxel 80qo cases reaction occurs within the medication IO min therefore strictly control the infusion rate, infusion beginning 10 min. 2.5 h drip drip rate of 10 drops / min, the absence of discomfort, drip rate can be raised to 45 drops / min (5) the use of the trial the amount of the first intravenous infusion of 30 mg, 30 min IAJ runs out, there is no anti-severe allergic reactions full amount. ⑥ someone close observation of vital signs change, the start of chemotherapy that is given ECG infusion every 10mln monitoring a blood pressure, pulse, respiration, supervised 30 min later measured every 1 h, and detailed records monitoring should be closely observed, asked whether patients discomfort, and found that allergic reactions, the group 3 patients l0min, facial flushing, rapid heart rate, and an immediate moratorium on the medication, dexamethasone 20 mg intravenously, oxygen, about symptoms after 30 min, the remaining amount of drugs used up to 30 drops / min. these reactions may be thinner poly ethyl generation castor oil contained in the paclitaxel injection l patients treated after symptoms can not be relieved, breathing difficulties disable paclitaxel alternative chemotherapy. reposted in the free papers Download Center http://eng.hi138.com
3.4 cardiotoxicity care
Cardiotoxicity of paclitaxel: bradycardia, heart block, atrial arrhythmias, myocardial ischemia and myocardial infarction, bradycardia most common, 30% of the incidence of routine examination before treatment, ECG, and learn more about whether the patient history of heart disease, medication given full ECG monitoring, the dynamic observation ECG changes, and inquired about the patient's symptoms, to prevent the occurrence of serious cardiac toxicity. abnormal electrocardiogram shaped discontinued immediately, the cardiologist to assess cardiac function given symptomatic treatment, reduce cardiac toxicity.
3.5 prevention of phlebitis care
The correct route of administration can prevent phlebitis, the first in a planned, rational choice and protect the vein from distal to proximal, gradually to the proximal end of the left and right side alternately, the application of intravenous catheter, gentle movements, selected soft , straight, flexible blood vessels, to ensure to puncture accurate success rate, to prevent the repeated puncture caused by subcutaneous ecchymosis or hematoma, if necessary, using the internal jugular deep venous catheter or PICC catheter guide to ensure the needle with saline before chemotherapy China available in intravenous chemotherapy drugs, and then the end of the chemotherapy drug infusion isotonic saline infusion of 50 to 100 mg, the reduction of drug stimulation, close observation of the puncture site with or without the infusion process Solution leakage, swelling, induration. drug leak extravascular promptly discontinued suction intravascular drug solution, local cold 33% magnesium sulfate, the coated Hirudoid ointment.
3.6 bone marrow suppression Care
Paclitaxel on bone marrow inhibition generally occurs 8-10 days after chemotherapy, bone marrow hematopoietic function was inhibited, the main cause leukopenia, WBC less than 1.0 × 109 / L should be given protective isolation to prevent infection occurred sepsis, the daily ultraviolet disinfection room, room to clean, reduce visitation, medical staff contact with patients to wear masks, no contact with relatives and health care workers with upper respiratory tract infection. platelets less than 50 x 109 / L to observe the skin and mucous membrane presence or absence of abnormal bleeding, etc., Zhu Huanzhe bed rest, slow activity, to avoid injury, use a soft toothbrush, the gentle care operations, to prevent bleeding.
Paclitaxel gastrointestinal reactions often nausea, vomiting, diarrhea, oral mucosa Yandeng, affecting patients with eating and normal digestive activity, frequent vomiting can cause water electrolyte balance disorders. Chemotherapy began to correctly assess the pain caused by the treatment, do good care measures include: ① effective choice town spit agent, ② selection of light, easily digestible liquid food, eat more fresh vegetables and fruits, Shaoshiduocan adjust feeding time to avoid eating 1 -2 h before chemotherapy and after chemotherapy , ③ distraction, such as listening to music, watching TV, reading the newspaper, play games or chat with your family ④ vomiting timely removal of vomit, oral care, reduce adverse stimuli.
3.8 alopecia care
Paclitaxel alopecia incidence of 80%, after the first chemotherapy before good psychological care to explain to patients the possibility of hair loss occurs, and withdrawal can be re-grow brighter, better hair, patients psychologically prepared to chemotherapy after alopecia patients to encourage its utter feeling to help choose the wigs or headscarves, reduce patient image disorder, anxiety, sadness and other negative emotions.
4 Summary Taxol is a plant-based anti-cancer drugs, adjuvant chemotherapy has been widely used in gynecological malignancies malignancy through application of paclitaxel-based combination chemotherapy in 326 patients with the care of patients with gynecologic malignancies, our experience in clinical chemotherapy nursing work nurses need to have complete control of the chemotherapy drug toxicity characteristics to be closely monitored and observed drug toxicity during chemotherapy
Do all the preventive measures, good psychological care, prevention and mitigation of toxicity should be to ensure the smooth progress of chemotherapy in order to achieve the desired therapeutic effect.
References Shen Jian, LANG Jing and epithelial ovarian cancer diagnosis and treatment, should pay attention to the problem of the Journal of Obstetrics and Gynecology, 2003,38,67 Links to free papers Download Center http://eng.hi138.com