家庭吞咽训练计划对头颈部肿瘤放疗患者吞咽功能的效果

doi:10.3969/j.issn.1006-9771.2022.02.014

摘要/Abstract

摘要：

目的探讨家庭吞咽训练计划对头颈部肿瘤放疗患者吞咽功能的改善作用。方法选取2020年9月至2021年9月北大荒集团总医院肿瘤科接受放疗的头颈部肿瘤患者45例,随机分为对照组(n = 23)和观察组(n = 22)。对照组采用常规治疗,观察组在对照组的基础上,进行14周的吞咽训练计划,包括在院期间6周的个体化指导训练和离院后8周的居家式训练。分别于训练前、训练6周和训练14周,比较两组门齿距、体质量、洼田饮水试验(WST)和功能性经口摄食量表(FOIS)评分。结果训练前,两组门齿距、体质量、WST和FOIS评分均无显著性差异(P > 0.05)。训练6周和14周,观察组门齿距、WST和FOIS评分均优于对照组(|Z| > 2.332, P < 0.05)。结论家庭吞咽训练计划有利于改善放疗引起的张口受限、吞咽困难情况,且家庭吞咽训练计划简单、安全、经济,操作性强,值得临床推广。

关键词: 头颈部肿瘤, 放射治疗, 家庭吞咽训练计划, 康复, 吞咽困难

Abstract:

Objective To explore the effect of family swallowing training program on swallowing function in patients with head and neck cancer after radiotherapy. Methods From September, 2020 to September, 2021, 45 patients with head and neck tumors who received radiotherapy in the oncology department of Beidahuang Industry Group General Hospital were randomly divided into control group (n = 23) and observation group (n = 22). Both groups received routine treatment, and the observation group received swallowing training program for 14 weeks at the beginning of radiotherapy, including six weeks of individualized guidance training in hospital and eight weeks of home training after leaving the hospital. The incisors spacing, body mass, Kubota Water Swallowing Test (WST) and Functional Oral Intake Scale (FOIS) were compared at the beginning of training, six weeks and 14 weeks after training. Results At the beginning of training, there was no significant difference in incisor spacing, body mass and the scores of WST and FOIS between two groups (P > 0.05). Six weeks and 14 weeks after training, the incisors spacing, and the scores of WST and FOIS were better in the observation group than in the control group (|Z| > 2.332, P < 0.05). Conclusion Family-based swallowing training program is helpful to improve the limitation of mouth opening and dysphagia caused by radiotherapy. Family-based swallowing training program is simple, safe, economical and highly operable, which is worthy of clinical promotion.

Key words: head and neck cancer, radiotherapy, family-based swallowing training program, rehabilitation, dysphagia

中图分类号:

R730.5

王晓雪,杨晨,孙菲,杜芊华,张俊. 家庭吞咽训练计划对头颈部肿瘤放疗患者吞咽功能的效果[J]. 《中国康复理论与实践》, 2022, 28(2): 227-231.

WANG Xiaoxue,YANG Chen,SUN Fei,DU Qianhua,ZHANG Jun. Effect of family-based swallowing training program on swallowing function for patients with head and neck cancer undergoing radiotherapy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(2): 227-231.

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参考文献 28

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组别	n	年龄/岁	性别/n		疾病类型/n					分期/n				平均放射剂量/cGy	总放疗剂量/cGy
组别	n	年龄/岁	男	女	喉	鼻咽	下咽	口咽	其他	I	II	III	IV	平均放射剂量/cGy	总放疗剂量/cGy
对照组	23	57.35±12.34	18	5	7	5	5	4	2	6	4	4	9	206.26±6.88	6543.48±541.74
观察组	22	59.23±7.13	17	5	8	3	5	3	3	4	4	3	11	208.04±8.84	6545.45±595.80
t/χ²/Z值		-0.622	0.006		1.503^a					-0.733				-0.449	-0.144
P值		0.537	0.936		0.895					0.463				0.654	0.886

组别	n	训练前	训练6周	训练14周
对照组	23	4.89±0.31	3.77±0.40	4.30±0.45
观察组	22	4.81±0.40	4.33±0.43	4.69±0.36
t值		0.728	-4.546	-3.265
P值		0.470	< 0.001	0.002

组别	n	训练前	训练6周	训练14周
对照组	23	64.44±10.43	54.22±8.74	60.85±9.03
观察组	22	65.77±6.92	58.11±7.11	64.52±6.18
t值		-0.504	-1.636	-1.587
P值		0.617	0.109	0.120

组别	n	WST			FOIS
组别	n	训练前	训练6周	训练14周	训练前	训练6周	训练14周
对照组	23	1(1, 2)	3.5(2, 5)	2(1, 5)	7(6, 7)	4(3, 6)	6(3, 7)
观察组	22	1(1, 2)	2.5(2, 4)	1(1, 5)	7(6, 7)	5(4, 7)	7(3, 7)
Z值		-1.157	-3.334	-2.332	-0.810	-3.258	-2.895
P值		0.247	0.001	0.020	0.418	0.001	0.004