Kemoterapi Alan Pediatrik Onkoloji Hastalarında Oral Mukozit Yönetimi: Kanıt Temelli Uygulamaların Değerlendirilmesi

Year 2022, Volume: 9 Issue: 2, 225 - 232, 31.08.2022

Gizem Çakır Naime Altay Ebru Kılıçarslan Törüner

https://doi.org/10.31125/hunhemsire.1167350

Abstract

Oral mukozit, pediatrik popülasyonda kanser tedavileriyle ilişkili en yaygın görülen yan etkilerden biridir. Oral mukozanın eritamöz ve ağrılı ülseratif lezyonlarıyla seyretmektedir. Kanser tedavilerinde farmakolojik ve integratif tedavi yönetimlerine karşın mukozit görülme sıklığı fazladır. Oral mukozitin önlenmesinde/tedavisinde kullanılan farklı metodlar ve terapötik ajanlar bulunmaktadır. Bunlar; temel ağız bakım protokolü, antimikrobial ajanlar, kriyoterapi, antiseptik ajanlar, antibiyotikler, vitaminler, sitokinezler, immun regülatörler ve bitkisel yöntemlerdir. Temel ağız bakım protokollerinde medikal olmayan gargaralar önerilmektedir. Klorheksidin, normal salin, sodyum bikarbonat ve benzidamin içeren gargaraların oral mukozitin önlenmesine ilişkin kesin kanıtları yoktur. E vitamini, oral mukozit şiddetini azaltmada etkili bir tedavi yöntemi olabilmektedir. Kriyoterapi, kemoterapi alan ve koopere çocuklarda mukozit derecesine göre tercih edilebilir bir tedavi yöntemidir. Klorheksidinin, lazer terapinin ve glutaminin çocuklarda kullanımıyla ilgili literatürde farklı sonuçlar bulunmaktadır ve pediatrik onkoloji hastalarında kullanımına yönelik sistematik derleme ve meta-analiz çalışmalarında etkinliği gösterilene kadar kullanımından kaçınılması önerilmektedir. Bu derlemenin amacı, kemoterapi alan pediatrik onkoloji hastalarında oral mukozitin önlenmesi ve tedavisinde önerilen ve önerilmeyen metodların ve ajanların incelenmesidir.

Keywords

Kanıt temelli uygulamalar, kemoterapi, oral mukozit yönetimi, pediatri, pediatri hemşireliği

Management of Oral Mucositis in Pediatric Oncology Patients Receiving Chemotherapy: Evaluation of Evidence-Based Practices

Abstract

Oral mucositis, which refers to erythematous and painful ulcerative lesions of the oral mucosa, is one of the most common adverse events associated with cancer therapies in the pediatric population. Although the pharmacologic and supportive therapy management of cancer treatment has advanced, the mucositis frequency is still increasing. Different methods and therapeutic agents are used in the prevention and treatment of oral mucositis, including basic oral care protocol, antimicrobial agents, cryotherapy, antiseptic agents, antibiotics, vitamins, cytokines, immune regulators, and herbal methods. Non-medical mouthwashes are recommended in basic oral care protocols. There is no conclusive evidence that mouthwashes contain chlorhexidine, normal saline, sodium bicarbonate, and benzydamine to prevent oral mucositis. Vitamin E can be an effective treatment method in reducing the severity of oral mucositis. Cryotherapy is a preferable treatment method according to the degree of mucositis in cooperative children receiving chemotherapy. There are different results in the literature regarding using chlorhexidine, laser therapy, and glutamine in children. It is recommended to avoid its use until its efficacy is demonstrated in systematic reviews and meta-analysis studies for its use in pediatric oncology patients. This review aims to evaluate the recommended and not recommended agents and practices in the prevention and treatment of oral mucositis in pediatric oncological patients receiving chemotherapy.

Keywords

Chemotherapy, evidence-based practice, management of oral mucositis, pediatric, pediatric nursing

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