背景:药物相关性颌骨坏死(MRONJ)是一种罕见的,但潜在的严重,暴露于骨改性剂后可能发生的不良事件(BMA;例如,双膦酸盐,denosumab,和抗血管生成疗法)。BMA通常在较高剂量下用于预防癌症患者的骨骼相关事件,而在较低剂量下用于骨质疏松症/骨丢失。MRONJ会引起很大的疼痛,降低生活质量,而且很难治疗,需要多专业的护理方法。
方法:我们回顾了文献和指南,总结了针对护士和其他专职医疗专业人员的MRONJ实用指南。
结果:虽然BMA存在MRONJ的风险,这应该考虑到治疗的好处。护士和其他专职医疗专业人员可以与医生和牙医一起在评估MRONJ风险方面发挥关键作用。确认MRONJ,为患者提供BMA治疗的获益-风险咨询,阻止MRONJ,并管理这些患者的护理途径。在开始BMA治疗之前评估患者的MRONJ危险因素可以指导预防措施以降低MRONJ的风险。护士可以通过与患者沟通,确保遵守预防措施,在促进MRONJ的多专业管理方面发挥关键作用。并与患者\'医生和牙医,以确保早期发现和转诊,以便及时治疗MRONJ。
结论:这篇综述总结了当前关于MRONJ的证据,并为护士提供了实践指导,从BMA治疗开始到可以采取的预防和管理BMA患者MRONJ的方法。
BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent, but potentially serious, adverse event that can occur after exposure to bone-modifying agents (BMAs; e.g., bisphosphonates, denosumab, and antiangiogenic therapies). BMAs are typically used at higher doses to prevent skeletal-related events in cancer patients and at lower doses for osteoporosis/bone loss. MRONJ can cause significant pain, reduce quality of life, and can be difficult to treat, requiring a multiprofessional approach to care.
METHODS: We reviewed the literature and guidelines to summarize a practical guide on MRONJ for nurses and other allied healthcare professionals.
RESULTS: While there is a risk of MRONJ with BMAs, this should be considered in relation to the benefits of treatment. Nurses and other allied healthcare professionals can play a key role alongside physicians and dentists in assessing MRONJ risk, identifying MRONJ, counseling the patient on the benefit-risk of BMA treatment, preventing MRONJ, and managing the care pathway of these patients. Assessing patients for MRONJ risk factors before starting BMA treatment can guide preventative measures to reduce the risk of MRONJ. Nurses can play a pivotal role in facilitating multiprofessional management of MRONJ by communicating with patients to ensure compliance with preventative measures, and with patients\' physicians and dentists to ensure early detection and referral for prompt treatment of MRONJ.
CONCLUSIONS: This review summarizes current evidence on MRONJ and provides practical guidance for nurses, from before BMA treatment is started through to approaches that can be taken to prevent and manage MRONJ in patients receiving BMAs.