颈静脉孔区神经鞘瘤切除术后并发嗓音嘶哑及吞咽障碍患者的康复护理1例  

Rehabilitation nursing of hoarseness and dysphagia after resection of schwannoma in jugular foramen:a case report

作　　者：陈丽鸥[1] 齐赛 王思琦 杨娜[1] 孙岩 张历 张静[1] 危维[1] 应波[2] 王振霖[1] Chen Liou;Qi Sai;Wang Siqi;Yang Na;Sun Yan;Zhang Li;Zhang Jing;Wei Wei;Ying Bo;Wang Zhenlin(Department of Otorhinolaryngology Head and Neck Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Nursing,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院耳鼻咽喉头颈外科,北京100053 [2]首都医科大学宣武医院护理部,北京100053

出　　处：《中国实用护理杂志》2022年第15期1186-1190,共5页Chinese Journal of Practical Nursing

摘　　要：目的总结1例颈静脉孔区颅内外沟通神经鞘瘤切除术后并发嗓音嘶哑、吞咽障碍患者的联合康复护理过程。方法2020年10月首都医科大学宣武医院收治1例左侧颈静脉孔区颅内外沟通肿瘤术后并发嗓音嘶哑及吞咽障碍的患者,早期实施呼吸肌舌肌运动辅助下的阶梯嗓音训练,以及基于电子喉镜为依据的呼吸吞咽方法、食物及一口量的评估、咀嚼次数辅助下食物稠度的维持和晋级饮食种类方法的吞咽摄食指导,提供全程连续的康复训练。结果通过术后至出院,出院后居家持续3个月的全程康复护理,嗓音嘶哑评估GRBAS分级标准从G3重度异常恢复至G2中度异常,嗓音障碍指数评估量表中文翻译版评分由75分降至52分,发音平均时间从2.45 s延长至5.32 s。进食呛咳次数从0.4~0.5次/min到无呛咳。结论早期给予嗓音和吞咽摄食康复训练,可促进颈静脉孔区神经鞘瘤切除术后嗓音嘶哑及吞咽障碍功能的康复。Objective To summarize the combined rehabilitation nursing process of a case of voice and deglutition disorders following surgical removal of intra-and extracranial schwannoma in the jugular foramen area.Methods A case of hoarseness and dysphagia after surgery for intracranial and extracranial schwannomas in the left jugular foramen region in Xuanwu Hospital,Capital Medical University in October 2020 was collected.Early step-wise voice training assisted by respiratory muscles and tongue muscle exercises was carried out,electronic laryngoscope-based breathing and swallowing methods,assessment of food and bite-size,maintenance of food consistency with the assistance of chewing times,and swallowing and ingestion guidance for the update of dietary methods were performed.The continuous rehabilitation training was provided throughout the process.Results The grade of GRBAS scale decreased from G3 to G2 after training from home for 3 months following discharge;the voice handicap index of Chinese version reduced from 75 points to 52 points,and the average pronunciation time extended from 2.45 s to 5.32 s.The frequency of choking with food optimized from 0.4 to 0.5 times/min to no choking.Conclusions Early rehabilitation training of voice and,swallowing and ingestion is a boon for the recovery of hoarseness and dysphagia after resection of schwannomas in the jugular foramen region.

关 键 词：护理 颈静脉孔区 神经鞘瘤 后组颅神损伤 快速康复 

分 类 号：R473.73[医药卫生—护理学]