吞咽训练在口腔癌术后加速康复中的效果评价

doi:10.19438/j.cjoms.2018.06.004

摘要/Abstract

摘要： 目的: 评估吞咽训练对口腔癌根治术后患者早期吞咽功能影响及影响吞咽训练效果的相关因素。方法: 对31例接受手术治疗后具有吞咽障碍的口腔癌患者进行吞咽训练,评估,记录患者吞咽训练前、后洼田饮水试验评级、曼恩评分及舌肌评级。吞咽训练后行吞咽造影,明确吞咽功能,指导拔除鼻饲管。采用SPSS 12.0软件包对数据进行统计学分析。结果: 31例患者口腔癌根治术后经过吞咽训练,吞咽功能短期内得到显著提高,洼田饮水试验评级、曼恩评分及舌肌评级在训练前、后均有统计学差异(P<0.05)。肿瘤T分期是唯一显著影响患者吞咽预后的因素（P=0.029）。另外,患者术后拔除鼻饲管时间平均为术后7.6 d。结论: 口腔癌根治术后患者的吞咽障碍在接受早期吞咽训练后能得到显著改善,患者吞咽障碍的早期诊断及介入训练对预后有积极影响,为患者拔除鼻饲管、安全经口进食提供了可靠的依据。

关键词: 吞咽训练, 术后加速康复, 口腔癌, 鼻饲管拔除

Abstract: PURPOSE: The purpose of this study was to evaluate the influence of swallowing training on early swallowing function in patients with oral cancer after radical mastectomy and related factors that influence the effect of swallowing training, and to enhance recovery of patients. METHODS: Thirty-one patients with oral cancer participated in the experimental study. All patients underwent surgery and dysphagia assessment and training. Water swallow test rating, MASA score and tongue muscle rating were recorded before and after swallowing training. After swallowing training, swallowing angiography was used to confirm swallowing function and guide removal of nasogastric tube. The data were analyzed with SPSS 12.0 software package. RESULTS: Swallowing function after swallowing training was significantly improved in 31 patients with oral cancer after radical mastectomy. The ratings of water swallow test, MASA score, and tongue muscle score were all significantly different before and after training. We found tumor T stage was the only factor that significantly affected the patient's swallowing prognosis (P=0.029). In addition, the average time for removal of nasogastric tube after surgery was 7.6 days after surgery. The standards for nasogastric feeding tube removal after radical oral cancer treatment were initially proposed. CONCLUSIONS: Patients with oral cancer after radical mastectomy were significantly improved after receiving early swallowing training, which helped patients return to normal life as soon as possible and accelerate recovery. Early diagnosis and intervention of dysphagia in patients with oral cancer after radical mastectomy have a positive impact on final prognosis, which provide reliable guidance for patients to remove nasogastric tube and safe oral intake. Early swallowing training after radical oral cancer surgery is worthy of clinical promotion.

Key words: Swallowing training, Enhanced recovery after surgery, Oral cancer, Nasogastric tube removal

中图分类号:

R739.8

蒋通辉, 王延, 庄海, 张继生, 卜寿山. 吞咽训练在口腔癌术后加速康复中的效果评价[J]. 中国口腔颌面外科杂志, 2018, 16(6): 498-504.

JIANG Tong-hui, WANG Yan, ZHUANG Hai, ZHANG Ji-sheng, BU Shou-shan. Application of swallowing training in enhanced recovery after surgery of oral cancer[J]. China J Oral Maxillofac Surg, 2018, 16(6): 498-504.

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