造血幹細胞移植患者に対する継続的口腔ケァの必要性: 病棟ラゥンド導入の試み

摘要

Recipients of hematopoietic stem cell transplantation (HSCT) suffer from many oral complications not only by chemotherapy and radiation therapy, but also by GVHD. Although it is impossible to prevent the oral complications completely, they can be minimized by continuing the oral care according to the each transplantation period by cooperation with dentists, dental hygienists, doctors, nurses, and nutritionists. So， especially in the clean room, we introduced a ward round by dentists and the successive oral care has been ongoing throughout the transplantation period. Mouth cleaning, mouth wash, moisturizing, mouthpiece wearing, pain control, bleeding control, and dietary instruction were conducted as oral care. The interest in oral care not only of the patients by themselves, but also of the doctors and the nurses could be advanced, and the cooperation among medical and dental staff members in the hospital became tightly by sharing the information of the patients as a united team.%造血幹細胞移植患者は化学療法や放射線療法によって，またGVHD(graftversushostdisease)によつて多くの口腔内有害事象に罹患する.これを完全に防ぐことは不可能であるが,歯科医師，歯科衛生士，医師，看護師，栄養士などが連携し，移植治療の各時期に応じた口腔ケアを行うことによって有害事象を最低限に抑えることができるものと考える.そこで当院では，特に歯科外来受診が困難で有害事象が最も起こりやすい無菌室入室期間に歯科ラウンドを導入することによって，移植期間を通じて継続的な口腔ケアを行っている.ケアとしては口腔清掃，含嗽，保湿，マウスピース装着，疼痛緩和や出血への対応，食事指導などが挙げられる.その結果，患者のみならず病棟での医師.看護師の口腔ケアに対する意識が向上すると同時に，チーム医療としての情報の共有がしゃすくなることによって院内での連携がスムーズになったと考えている.