系统性康复治疗对鼻咽癌放射治疗后进食困难的影响

Systematic rehabilitation relieves feeding difficulties induced by radiotherapy for nasopharyngeal carcinoma

目的观察系统性康复训练对鼻咽癌放射治疗后进食困难的治疗作用。方法选取2013年7月至2014年12月期间我院收治的鼻咽癌放疗后进食困难患者56例，采用随机数字表法将其分为观察组及对照组。2组患者住院期间均给予营养支持、抗感染、神经营养、改善微循环、口腔护理及常规张口、颈部活动训练，观察组患者同时给予系统性康复训练（包括主动训练及被动训练）。观察治疗前、后2组患者张口度、饮水试验、吞咽x线荧光透视检查（VFSS）、标准吞咽功能评估量表（SSA）评分及营养状况的变化情况。结果与对照组比较，观察组患者治疗后其张口距离明显增大[（3．33±0．51）cmVS（2．94±0．50）em]，饮水试验阳性率明显下降，SSA评分也显著降低[（22．4±6．4）分VS（27．3±5．4）分]，VFSS评分明显上升[（8．57±1．11）分VS（7．54±0．84）分]，同时患者营养状况也得到一定程度改善。结论早期、及时、全程、系统性康复干预有助于鼻咽癌放疗后进食困难患者张口及吞咽功能提高，对改善其生活质量具有重要意义，该疗法值得临床推广、应用。

Objective To explore the effect of systematic rehabilitation treatment on feeding performance af- ter radiotherapy treating nasopharyngeal carcinoma. Methods Fifty-six patients who had completed radiotherapy for nasopharyngeal carcinoma were randomly divided into an observation group and a control group, each of 28. Both groups were given nutritional support, infection prophylaxis, treatment for neurotrophy and to improve microcircula- tion, oral nursing and routine mouth opening and neck rehabilitation training. The observation group was given addi- tional positive and passive rehabilitation training. Mouth opening and drinking tests were administered, Videofluoros- copy （VFSS） and a standardized swallowing assessment （SSA） were used, and nutritional status was assessed before and after the treatment. Results The average mouth opening distance in the observation group was significantly greater than that in the control group after the treatment. The average positiveness rate in the drinking test and the av- erage SSA score had both decreased in the observation group significantly more than in the control group, and the av- erage VFSS score had increased significantly more. Conclusions Early, timely, full-duration and systematic reha- bilitation treatment can greatly improve the ease of food intake and the quality of life after radiotherapy for nasopharyn- geal carcinoma.