琼脂增稠剂在鼻咽癌放疗术后吞咽障碍患者中的应用及临床评价

Application of agar thickener in dysphagia after radiotherapy for nasopharyngeal carcinoma

目的观察比较新型琼脂增稠剂与传统黄原胶增稠剂在鼻咽癌放疗术后吞咽障碍患者应用中的差异。方法选取20例鼻咽癌放疗术后吞咽障碍患者,分别让其吞咽由琼脂或黄原胶增稠剂配制的中稠度及高稠度食物。通过吞咽造影(VFSS)定性、定量分析和主观性评价法评估患者应用情况。结果经吞咽造影数字化分析发现,入选患者在吞咽中稠度琼脂增稠剂食物时其咽腔收缩率(PCR)较吞咽中稠度黄原胶增稠剂食物时明显减小(P<0.05);患者吞咽高稠度琼脂增稠剂食物时其口腔运送时间(OTT)、咽期吞咽启动时间(IPS)和PCR均较吞咽高稠度黄原胶增稠剂食物时明显减少(P<0.05);在渗漏误吸方面,患者吞咽琼脂增稠剂食物和黄原胶增稠剂食物时并无明显差异。在主观性评价方面,患者吞咽琼脂增稠剂食物在爽滑感及残留感方面优于吞咽黄原胶增稠剂食物(P<0.01),但在香味方面劣于吞咽黄原胶增稠剂食物(P<0.01)。结论与吞咽黄原胶增稠剂食物比较,吞咽琼脂增稠剂食物能缩短食团运送时间,所需咽部收缩力量较小,口咽残留较少,口感更爽滑,可作为一种新型增稠剂广泛应用于鼻咽癌放疗术后吞咽障碍患者人群。

Objective To compare a new agar thickener with xanthan gum as a thickener in treating dysphagia patients with nasopharyngeal carcinoma after radiotherapy.Methods Twenty nasopharyngeal carcinoma patients with dysphagia after radiotherapy were asked to swallow moderately and extremely thick liquids thickened with the agar and xanthan gum,and their swallowing was recorded with a videofluoroscope.Results The average pharyngeal constriction ratio when swallowing agar thickener was significantly lower than when swallowing the traditional thickener.The average oral transit time,the initiation of pharyngeal swallowing were both significantly quicker.There was no significant difference in the average penetration aspiration scale scores between the two thickeners.In the subjective evaluation,the agar thickener was adjudged smoother and with better residual mouthfeel than the xanthan gum,but the scent of the xanthan gum was preferred.Conclusion The new agar thickener is smooth and not sticky.It produces faster transport with less oropharyngeal residue.It can be widely used among nasopharyngeal carcinoma patients with dysphagia after radiotherapy.