晚期食管癌放疗患者预防性置入鼻空肠营养管误吸风险及其影响因素  

Aspiration risk of preventive placement of nasal jejunum nutrition tube in advanced esophageal cancer patients receiving radiotherapy and the influencing factors

作　　者：王黎 高建[2] 王海虹 任雪君 隗伟[3] Wang Li;Gao Jian;Wang Haihong;Ren Xuejun;Wei Wei(Department of VIP Medical Service,Cancer Hospital,Chinese Academy of Medical Sciences,Beijing 100021,China;Department of Traditional Chinese Medicine,Radiotherapy 5,Cancer Hospital,Chinese Academy of Medical Sciences,Beijing 100021,China;Department of Comprehensive Medical Oncology,Cancer Hospital,Chinese Academy of Medical Sciences,Beijing 100021,China)

机构地区：[1]中国医学科学院肿瘤医院特需医疗部,北京100021 [2]中国医学科学院肿瘤医院放五中医病房,北京100021 [3]中国医学科学院肿瘤医院综合科,北京100021

出　　处：《肿瘤研究与临床》2023年第8期605-609,共5页Cancer Research and Clinic

摘　　要：目的探讨晚期食管癌放疗患者预防性置入鼻空肠营养管的误吸风险及其影响因素。方法回顾性分析2020年11月至2021年11月中国医学科学院肿瘤医院收治的220例行预防性置入鼻空肠营养管的晚期食管癌放疗患者的临床资料,依据标准吞咽功能评估量表(SSA)评估患者的误吸风险级别。制订一般资料调查表,内容包括患者一般资料:性别、年龄、文化程度、吸烟史、饮酒史、误吸知识知晓情况;疾病性因素:肿瘤分期、肿瘤部位、吞咽功能、是否腹胀;医源性因素:食管癌手术史、是否镇静镇痛治疗、是否联合化疗、累积放疗剂量、放射性食管炎分级、肠内营养体位、肠内营养滴注方式、肠内营养时间等。评估患者标准吞咽功能。采用反复唾液吞咽实验(RSST)用于筛查存在食管功能性吞咽困难的患者。采用多元线性回归分析患者误吸风险的影响因素。结果220例患者中,0级误吸风险70例(31.8%),SSA得分19分;Ⅰ级误吸风险23例(10.5%),SSA得分(23.4±1.3)分;Ⅱ级误吸风险103例(46.8%),SSA得分(27.5±1.1)分;Ⅲ级误吸风险24例(10.9%),SSA得分(33.2±1.5)分;共136例(61.8%)出现过误吸。知晓误吸相关知识的患者占32.7%(72/220)。多因素分析显示,食管肿瘤部位(t=-2.869,P=0.005)、累积放疗剂量(t=5.558,P<0.001)、放射性食管炎分级(t=11.405,P<0.001)、肠内营养持续时间(t=4.050,P<0.001)是患者误吸风险的独立影响因素。结论晚期食管癌放疗行预防性置入鼻空肠营养管患者误吸风险较高,误吸风险与食管肿瘤部位、放射性食管炎分级、累积放疗剂量、肠内营养持续时间相关。Objective To investigate the aspiration risk of preventive placement of nasal jejunum nutrition tube in advanced esophageal cancer patients receiving radiotherapy and the influencing factors.Methods The clinical data of 220 patients with advanced esophageal cancer who received radiotherapy and preventive placement of nasal jejunum nutrition tube feeding from November 2020 to November 2021 in Cancer Hospital,Chinese Academy of Medical Sciences were retrospectively analyzed.The level of aspiration risk was measured according to the standard swallowing function assessment scale(SSA).The questionnaire collected the following data:(1)the general data including gender,age,educational level,history of smoking,history of alcoholism,knowledge of aspiration;(2)the disease factors including tumor staging,tumor site,swallowing function,abdominal distention;(3)the nosocomial factors including history of esophageal cancer surgery,sedation and analgesia treatment,combination of chemotherapy or not,cumulative radiotherapy dose,grade of radiation esophagitis,the position,time and tube feeding method of enteral nutrition.The standard swallowing function of patients was measured and repeated saliva swallowing test(RSST)was used to screen the patients with the difficulty in the esophageal function swallowing.Multiple linear regression was used to analyze the factors affecting aspiration risk.Results A total of 220 patients with advanced esophageal cancer were enrolled in the investigation.Finally,70 patients(31.8%)had grade 0 aspiration risk,and SSA score was 19;23 patients(10.5%)had grade I aspiration risk,and SSA score was(23.4±1.3);103 patients(46.8%)had gradeⅡaspiration risk,and SSA score was(27.5±1.1);24 patients(10.9%)had gradeⅢaspiration risk,and SSA score was(33.2±1.5);136 patients(61.8%)in total had aspiration risk.There were 32.7%(72/220)patients knowing the knowledge of aspiration.Multifactor analysis showed that esophageal tumor site(t=-2.869,P=0.005),cumulative radiotherapy dose(t=5.558,P<0.001),grade of radiatio

关 键 词：食管肿瘤 放射疗法 肠内营养 误吸 

分 类 号：R735.1[医药卫生—肿瘤]