不同喉功能保留术式患者吞咽康复早期进食性状情况的研究  

Study on eating characteristics of early swallowing recovery in patients with different laryngeal function preserving operation

作　　者：裘成莉[1] 桂意华 郑亚华[2] 周艳[1] 黄琦[1] 邬振华[1] Qiu Chengli;Gui Yihua;Zheng Yahua;Zhou Yan;Huang Qi;Wu Zhenghua(Department of Otolaryngology Head and Neck Surgery,Ningbo Medical Treatment Center Lihuili Hospital,Ningbo 315040,China;Nursing Department,Ningbo Medical Center Lihuili Hospital,Ningbo 315040,China)

机构地区：[1]宁波市医疗中心李惠利医院耳鼻喉头颈外科,315040 [2]宁波市医疗中心李惠利医院护理部,315040

出　　处：《中国实用护理杂志》2021年第8期561-565,共5页Chinese Journal of Practical Nursing

基　　金：浙江省医药卫生科技计划(2019KY190);宁波市医疗卫生品牌学科建设项目(PPXK2018-02)。

摘　　要：目的研究不同喉功能保留术患者吞咽康复早期进食食物性状的变化。方法收集宁波市医疗中心李惠利医院2019年1月至2020年3月行喉功能保留术的喉癌下咽癌患者,采用纤维内镜吞咽检查(FEES)结合误吸评分量表(PAS),前瞻性观察患者在试进食早期进食固体、糊状、流质3种不同性状食物的误吸、误侵情况。结果69例患者中喉垂直部分切除术21例,部分咽部分喉切除术19例,术后15 d该2组患者对固体与糊状食物适应性评分分别为(1.14±0.36)、(1.29±0.56)分和(2.53±2.04)、(2.84±2.31)分,Friedman M检验进行3种食物性状适应性比较差异有统计学意义(M值为23.463、22.227,P<0.01),流质食物适应性评分为(2.10±1.09)、(4.42±2.24)分,流质与固体和糊状的成对比较差异有统计学意义(t值为-0.976~1.105,P<0.05);术后20 d该2组术式对3种食物性状适应性比较差异无统计学意义(P>0.05)。喉环状软骨上喉部分切除-环舌骨会厌吻合术(SLCP-CHEP)17例、喉声门上水平部分切除术12例,术后15 d该2组患者对3种食物性状适应性评分分别为(4.65±1.90)、(5.59±1.46)、(6.53±1.13)分和(6.67±1.07)、(4.50±2.07)、(6.92±0.79)分,M检验差异均有统计学意义(M值为29.525、22.136,P<0.01);术后20 d该2组术式中固体和糊状食物的成对比较差异无统计学意义(P>0.05),流质与固体和糊状比较差异均有统计学意义(t值为-1.375~-0.853,P<0.05)。结论喉功能保留术患者的早期康复中垂直组和部分咽部分喉切除术组对固体和糊状食物适应性较好,水平组对糊状适应性较好,CHEP组对固体适应性较好,4组对流质的适应性均最差,且CHEP组与水平组对流质的康复需要更长时间。了解不同术式患者在试进食早期对食物性状的适应性,有助于实施针对性的康复方案,开展逐步递进式饮食训练,降低康复周期内误侵、误吸、吸入性肺炎等并发症。Objective To study the changes of food characters in early swallowing recovery in patients with different laryngeal function preservation surgery.Methods Collected patients with laryngeal cancer hypopharyngeal cancer who underwent laryngeal function preservation surgery in Lihuili Hospital of Ningbo Medical Center from January 2019 to March 2020.By fiberoptic endoscopic evaluation of swallowing(FEES)combined with Penetration and Aspiration Scale(PAS),prospectively observed the aspiration and invasion of solid,paste,fluid and other food in the early stage of trial feeding in patients with laryngeal hypopharyngeal cancer undergoing open laryngeal function preservation.Results Among the 69 patients,21 had vertical partial laryngectomy and 19 had partial pharyngeal partial laryngectomy.15 days after the operation,2 groups of patients after solid and paste food adaptability scored(1.14±0.36),(1.29±0.56)and(2.53±2.04),(2.84±2.31)points,Friedman Mtest for comparison difference had statistical significance(Mvalues were 23.463 and 22.227,P<0.01);the liquid food for adaptability scored(2.10±1.09),(4.42±2.24)points,the pairwise comparison of liquid,solid and paste showed statistically significant differences(tvalues were-0.976 to 1.105,P<0.05).The pairwise comparison of the adaptability of the two groups on 20 days after surgery showed no statistically significant difference(P>0.05).Throat on the cricoid cartilage resection-ring hyoid epiglottis anastomosis(SLCP-CHEP)was 17 cases,laryngeal glottis level partial resection was 12 cases;postoperative 15 days the adaptability on the behavior of three kinds of food grade 2 groups of patients(4.65±1.90),(5.59±1.46),(6.53±1.13)points and(6.67±1.07),(4.50±2.07),(6.92±0.79)points,respectively;Minspection differences were statistically significant(Mvalues were 29.525,22.136,P<0.01).The pairwise comparison of solid and paste food in the two groups 20 days after the operation showed no statistically significant difference(P>0.05),while the difference of liquid and paste was

关 键 词：喉肿瘤 下咽肿瘤 喉功能保留术 吞咽障碍 吞咽康复 食物性状 

分 类 号：R739.6[医药卫生—肿瘤]