喉部分切除病人早期吞咽康复管理的最佳证据总结

Evidence summary of early swallowing rehabilitation management in patients after partial laryngectomy

目的:总结喉部分切除病人早期吞咽康复管理的最佳证据。方法:确立循证问题,依据“6S”证据模型,自上而下检索BMJ最佳临床实践、Up to Date、国际指南协作网等国内外数据库中关于喉部分切除术病人吞咽康复管理的证据,检索时限为建库至2021年4月1日。由2名研究者独立进行文献质量评价,并对最终纳入文献的证据进行整合。结果:共纳入文献18篇,其中包括3篇指南,5篇专家共识,6篇系统评价以及4篇随机对照试验。最终总结证据24条,涉及预防性康复运动、评估、营养管理、间接吞咽功能锻炼、代偿策略、口腔护理、呼吸训练及多学科管理8个维度。结论:喉部分切除病人早期吞咽康复管理的最佳证据总结形成过程严谨、科学,具有一定的临床实用性,有助于护理人员根据喉部分切除病人临床实际制订规范化、系统化的早期吞咽康复管理策略。

Objective:To summary the relevant evidence of early swallowing rehabilitation training in patients after partial laryngectomy.Methods:The evidence⁃based questions were established.According to the"6S"evidence model,the evidence of swallowing rehabilitation management in partial laryngectomy was searched from BMJ Best Clinical Practice,Up to Date,International Guidelines Collaboration network and other domestic and foreign databases.The retrieval time was from the database establishment to April 1,2021.The quality of the literature was evaluated independently by two researchers,and the evidence of the final included literature was integrated.Results:A total of 18 studies were included,where were 3 guidelines,5 expert consensus,6 systematic reviews,and 4 randomized controlled trials.It summarized 24 evidence,involving 8 aspects of preventive rehabilitation exercise,evaluation and screening,nutrition management,swallowing function exercise,compensatory strategies,oral nursing,respiratory training,and multidisciplinary management.Conclusion:The process of summarized best evidence for early swallowing rehabilitation management of patients with partial laryngectomy is rigorous,scientific and has certain clinical practicability.It is helpful for clinical nurses to formulate standardized and systematic early swallowing rehabilitation management strategies according to the clinical reality of patients with partial laryngeal resection.