90%接受放射線治療之頭頸部癌症病人會發生口腔黏膜炎，易造成續發性口腔感染及影響生活品質，系統性的口腔護理措施有助於降低口腔黏膜炎發生的可能性。臨床上最常用的漱口液為寶馬生(Chlorhexidine)，但蜂膠也常被使用(Propolis)；但目前少有研究比較蜂膠及寶馬生對口腔黏膜炎成效之差異情形，因此，本研究目的為比較蜂膠與寶馬生兩種不同漱口液，對於接受放射線治療之頭頸部癌症病人的口腔黏膜變化、口腔續發性感染及口腔舒適感受之差異。
本研究採類實驗設計，研究對象為南部某醫學中心之頭頸部腫瘤病人初次接受放射線治療者，共收案44位，其中實驗組24人使用0.4%蜂膠漱口，對照組20人使用0.1%寶馬生漱口，所有參與者皆由研究者教導PRO-SELFC Mouth Aware口腔清潔方案(Larson et al., 1998)，並搭配不同漱口水。以『WHO口腔黏膜炎等級』與『口腔黏膜評估表』(OMAS)兩種量表來評估病人的口腔黏膜狀態；以口腔致病菌培養及臨床診判斷來評估口腔續發性感染情形、以口腔疼痛評估視覺量表和對漱口水耐受度量表來評估口腔舒適感受，初次評估時機為開始接受放射線治療的五次之內，之後每隔治療三次收集一次資料，而口腔致病菌培養為每兩週採檢一次，整個方案直到放射線治療結束為止。本研究所得的資料結果，以SPSS/Window 14.0版套裝軟體進行資料建檔與分析，描述性資料主要採用chi-square test以及Independent t-test，兩組時間序列的比較性資料主要採用Mixed model以及Survival curve來分析。
研究結果顯示蜂膠與寶馬生不同漱口液在口腔黏膜炎、發生嚴重三級口腔黏膜炎個案數、經放射線治療至發生口腔黏膜炎的時間、經放射線治療至診斷發生口腔白色念珠菌時間、口腔內菌落數包括白色念珠菌、格蘭氏陰性菌及金黃色葡萄球菌菌落數均無差異。在舒適感受方面，兩組在口腔疼痛上亦無顯著差異，但對漱口水耐受度上，蜂膠組比寶馬生組在整體的漱口水耐受度低，其耐受度較佳(F=14.730，p< .001)。整體而言，蜂膠用於口腔漱口與寶馬生之安全性相當，且使用者有較佳的耐受度，故建議臨床上可考慮使用蜂膠漱口來代替臨床常規之寶馬生漱口水之可行性，惟在蜂膠漱口水的濃度調配需專業人員指導。

Background: Oral mucositis is the most symptomatic problem of patients in head and neck cancer patients with radiotherapy. The impaired oral function, secondary infections, and pain may cause distress and altered the patient’s quality of life. Chlorhexidine is a commonly prescribed mouthwash for oral complications. Currently bee propolis has been used as an alternative mouthwash. However, little study has documented whether propolis has a similar effects to Chlorhexidine. Therefore, this study aimed to compare effects of propolis and Chlorhexidine on oral mucositis, flora of candidiasis, streptococcus, and Gram-negative bacterium, and preference in head and neck cancer patients with radiotherapy.
Methods:A quasi-experimental study was used in 44 subjects. Each subject followed the same protocol of oral care. However, 24 of them used 0.4% propolis and 20 used 0.1%Chlorhexidine to rinse their mouths. The WHO Grade System and Oral Mucositis Assessment Scale were used to measure severity of oral mucositis with an interval of three-time radiotherapy. Floras of bacteria and candidiasis were cultivated in a two-week interval. The patient’s preference was measured with a Pain Visual Analogue Scale and l-5 Likert scale for tolerance. Mixed model, independent t-test, Mann-Whitney U test, and survival curve were used for statistical testing.
Results: No significant difference in onset and severity of oral mucositis, floras of candidiasis, streptococci, Gram-negative bacterium, and pain sensation between subjects used propolis and Chlorhexidine mouthwashes. However, the tolerance of propolis is better than Chlorhexidine (F=14.730，p< .001).
Conclusion: The propolis mouthwash has a similar effect to Chlorhexidine and produce less discomfort in head and neck cancer patients with radiotherapy. Concerning the patient’s preference, it can be used as alternative selection for oral hygiene.

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