凝固粉在全腔镜食管癌根治术后并发吞咽障碍患者中的应用效果研究

Clinical Application of Coagulation Powder in Patients with Swallowing Dysfunction after Endoscopic Radical Surgery for Esophageal Cancer

目的观察凝固粉对全腔镜食管癌根治术后并发吞咽障碍患者营养状态、近期生存质量及临床并发症的影响。方法选取2015年6月—2017年3月于河北医科大学第四医院胸外科确诊为食管癌并行全腔镜食管癌根治术后并发喉返神经损伤致吞咽障碍患者78例,采用随机数字表法将其分为试验组(40例)和对照组(38例)。患者均给予吞咽功能训练,对照组给予常规术后饮食,试验组在普通饮食的基础上加服凝固粉。于治疗前后采用标准吞咽功能评定量表(SSA)、生存质量问卷(EORTC-QLQ-C30)进行评分,测定清蛋白及血红蛋白,记录术后吸入性肺炎、便秘发生率。结果治疗2、4周后试验组SSA评分均低于对照组(P<0.05)。试验组出院1个月的总体健康状况、躯体功能、情感功能、社会功能、认知功能、角色功能评分均高于对照组,疲劳、恶心呕吐、疼痛、失眠、呼吸困难、食欲下降、便秘、腹泻、经济困难评分均低于对照组(P<0.05)。治疗4周后试验组清蛋白、血红蛋白水平均高于对照组(P<0.05)。试验组吸入性肺炎、便秘发生率均低于对照组(χ~2=3.921、4.647,P<0.05)。试验组、对照组患者治疗4周后SSA评分与总体健康状况评分均呈负相关(r=-0.805、-0.787,P<0.05)。结论在以吞咽功能训练为主的综合康复干预基础上加用凝固粉,能有效地改善全腔镜食管癌术后并发吞咽障碍患者的吞咽功能,减少并发症的发生,提高患者生活质量,促进其快速康复。

Objective To observe the effects of coagulation powder on nutritional status,quality of life(QOL),and clinical complications in patients with swallowing dysfunction after endoscopic radical surgery for esophageal cancer.Methods Seventy-eight patients were enrolled at the Fourth Hospital of Hebei Medical University from June 2015 to March 2017.All had swallowing dysfunction caused by laryngeal nerve injury associated with endoscopic radical surgery for esophageal cancer.They all received swallowing therapy and were randomly assigned postoperatively to either a routine diet(the control group,n=38)or a routine diet plus coagulation powder(the experimental group,n=40).The standardized swallowing assessment(SSA)and the EORTC Quality of Life Questionnaire-Core 30(EORTC-QLQ-C30)were administered before and after treatment.Albumin and hemoglobin were assayed and the occurrence of postoperative aspiration pneumonia and constipation was monitored.Results After 2 and 4 weeks of treatment,the SSA scores of the experimental group were significantly lower than those of the control group(P<0.05).The scores of general health,physical function,emotional function,social function,cognitive function and role function in the experimental group after one month of discharge were higher than those in the control group,and the scores of fatigue,nausea and vomiting,pain,insomnia,dyspnea,loss of appetite,constipation,diarrhea and economic difficulty were lower than those in the control group(P<0.05).After 4 weeks of treatment,the albumin and hemoglobin levels of the experimental group were significantly higher than that of the control group(P<0.05).The incidence of aspiration pneumonia and constipation in the experimental group was lower than that in the control group(χ2=3.921,χ2=4.647,P<0.05).SSA and overall health status scores were negatively correlated in both the experimental group and control group at 4 weeks after treatment(r=-0.805,r=-0.787,P<0.05).Conclusion Including coagulation powder in a comprehensive rehabilitation intervention improved swallowing dysfunction,reduced complications,improved QOL,and promoted patient recovery after endoscopic radical surgery for esophageal cancer.