三种干预方法在急性淋巴细胞白血病大剂量甲氨蝶呤化疗性口腔黏膜炎中的应用及临床经济学评价

Application and clinical economic evaluation of three intervention methods in high-dose methotrexate chemotherapy-induced oral mucositis in acute lymphoblastic leukemia

摘要:

目的 探讨蜂蜜、低温氧气雾化及常规漱口水对急性淋巴细胞白血病（ALL）患者化疗性口腔黏膜炎（CIOM）的临床效果和成本效益。 方法 选取2023年2-5月宁夏银川市某三甲医院血液内科住院治疗且符合纳入排除标准的129例ALL患者，随机分为蜂蜜组、低温氧气雾化组和常规漱口水组，每组43例。化学治疗期间，蜂蜜组用蜂蜜涂抹于口腔黏膜表面；低温氧气雾化组以粒细胞刺激因子为雾化液，经低温氧气雾化吸入；常规漱口水组用医嘱漱口水漱口。 结果 蜂蜜组、低温氧气雾化组和常规漱口水组分别有7例（16.28%）、9例（20.93%）和20例（46.51%）患者发生CIOM，三组患者CIOM发生率及严重程度比较，差异具有统计学意义（H=11.598，P=0.003）。蜂蜜与低温氧气雾化对ALL患者CIOM的预防与治疗效果均优于常规漱口水（均P < 0.05），但蜂蜜与低温氧气的预防与治疗效果比较，差异无统计学意义（P>0.05）。蜂蜜组的成本低于低温氧气雾化组及常规漱口水组（均P < 0.05），低温氧气雾化组虽有一定治疗效果，但成本远高于蜂蜜组与常规漱口水组（均P < 0.05）。 结论 蜂蜜对ALL患者CIOM具有较好的防治效果，同时可以降低患者的医疗费用。

Abstract:

Objective To explore the clinical efficacy and cost-effectiveness of honey, low-temperature oxygen atomization and conventional mouthwash on chemotherapy-induced oral mucositis (CIOM) in patients with acute lymphoblastic leukemia (ALL). Methods 129 ALL patients who were hospitalized in the hematology department of a tertiary first-class hospital in Yinchuan City of Ningxia from February to May 2023 and met the inclusion and exclusion criteria were selected, they were randomly divided into honey group, low-temperature oxygen atomization group, and conventional mouthwash group, with 43 cases in each group. During chemotherapy period, the honey group applied honey to oral mucosa surface, the low-temperature oxygen atomization group inhaled granulocyte stimulating factors through low-temperature oxygen atomization, the conventional mouthwash group gargled with prescribed mouthwash. Results There were 7(16.28%), 9(20.93%), and 20(46.51%) patients with CIOM in honey group, low-temperature oxygen atomization group, and conventional mouthwash group, respectively. The incidence and severity of CIOM among three groups of patients were statistically different (H=11.598, P=0.003). Honey and low-temperature oxygen atomization were superior to conventional mouthwash in the prevention and treatment efficacy on CIOM in ALL patients (both P < 0.05), but the efficacy was no statistically different between honey and low-temperature oxygen atomization (P>0.05). The cost of honey group was lower than low-temperature oxygen atomization group and conventional mouthwash group (both P < 0.05), although the low-temperature oxygen atomization group has certain therapeutic effect, its cost was much higher than that of the honey group and the conventional mouthwash group(both P < 0.05). Conclusion Honey has a better prevention and treatment effect on CIOM in ALL patients, and can also reduce the hospitalization cost of patients.