呼吸功能训练联合球囊扩张术在鼻咽癌放疗后环咽肌失弛缓的康复治疗中的应用  

Combining respiratory function training with balloon dilatation for the rehabilitation of cricopharyngeal achalasia after radiotherapy for nasopharyngeal carcinoma

作　　者：刘诗丹[1] 陈启波[1] 李荣祝[1] 韦汶伽 Liu Shidan;Chen Qibo;Li Rongzhu;Wei Wenjia(Department of Rehabilitation,People′s Hospital of the Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院康复科,广西530021

出　　处：《中华物理医学与康复杂志》2021年第8期700-704,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2018058)。

摘　　要：目的探讨呼吸功能训练联合球囊扩张术对鼻咽癌放疗后环咽肌失弛缓患者吞咽功能恢复的影响。方法采用随机数字表法将120例鼻咽癌放疗后环咽肌失弛缓患者分为观察组和对照组,每组60例,对照组给予常规吞咽功能康复训练及球囊扩张术治疗,观察组在此基础上辅以呼吸功能训练,每周训练5 d,持续训练8周。分别于治疗前、治疗4周和治疗8周后,采用通过吞咽造影检查评分(VFSS)、功能性经口摄食量表评分(FOIS)、环咽肌功能状态及安德森吞咽困难量表(MDADI)对2组患者的吞咽功能进行疗效评定。结果治疗4周后,2组患者的VFSS、FOIS及MDADI各项评分均较组内治疗前明显升高(P<0.05),且随着治疗时间的延长,上述评分均升高更加显著(P<0.05)。治疗8周后,观察组患者的VFSS评分[(8.02±0.89)分]、FOIS评分[(5.36±0.79)分]及MDADI评分[总体(4.27±0.64)、生理(34.70±3.38)、功能(22.14±1.78)、情感(27.09±2.70)分]与组内治疗前[(2.13±0.35)、(1.50±0.40)、(2.65±0.42)、(19.37±0.45)、(13.14±0.49)和(17.43±1.20)分]相比均有明显改善(P<0.05),且观察组较同时间点对照组[(4.65±0.72)、(3.14±0.70)、(3.77±0.54)、(26.82±2.38)、(20.64±1.95)和(25.64±2.62)分]改善更为显著,组间差异有统计学意义(P<0.05)。结论呼吸功能训练协同球囊扩张术可对鼻咽癌放疗后环咽肌失弛缓患者的吞咽功能改善有促进作用,可明显减轻或延缓鼻咽癌放疗后出现的吞咽障碍。Objective To observe the rehabilitative effect of combining respiratory function training with balloon dilatation for persons with cricopharyngeal achalasia after radiotherapy for nasopharyngeal carcinoma.Methods A total of 120 nasopharyngeal carcinoma patients with cricopharyngeal achalasia after radiotherapy were randomly divided into an observation group and a control group,each of 60.Both groups were treated with routine functional swallowing training and balloon dilatation,while the observation group was additionally provided with respiratory function training 5 days a week for 8 weeks.Before the treatment and after 4 and 8 weeks of treatment,the swallowing function of both groups was evaluated using video fluoroscopy(VFSS),a functional oral intake scale(FOIS),cricopharyngeal muscle functional status and the M.D.Anderson dysphagia inventory(MDADI).Results After 4 weeks of treatment the average VFSS,FOIS and MDADI scores of both groups were significantly better than before the treatment,and significant improvement continued over the subsequent four weeks.After 8 weeks of treatment,the average VFSS,FOIS and MDADI scores of the observation group had again improved significantly.Physiology,functioning,and their emotional state were also adjudged to have improved compared with 4 weeks earlier and compared with the control group.Conclusion Combining respiratory function training with balloon dilatation can improve swallowing and can significantly reduce or delay swallowing disorders among patients with cyclopharyngeal achalasia after radiotherapy.

关 键 词：鼻咽癌 呼吸功能训练 球囊扩张 环咽肌失弛缓 

分 类 号：R739.63[医药卫生—肿瘤] R493[医药卫生—临床医学]