早期主动呼吸循环技术对喉部分切除术后吞咽障碍患者误吸的效果

Effect of Early Active Cycle of Breathing Technique Training on Aspiration in Patients with Dysphagia after Partial Laryngectomy

目的 探讨早期主动呼吸循环技术(active cycle of breathing technique,ACBT)对喉部分切除术后吞咽障碍患者误吸的效果。方法 选取2019年1月~2022年1月在中南大学湘雅三医院耳鼻喉科住院的喉癌术后吞咽障碍患者40例,采用随机数字法将患者随机分为观察组和对照组各20例,对照组给予常规吞咽功能训练,观察组在对照组的基础上结合ACBT。两组每周治疗5日,每日治疗2次,每次45 min,持续2周,比较两组患者治疗前后的安德森吞咽困难量表(M.D.Anderson dysphagia inventory,MDADI)、最长发声时间(MPT)、标准吞咽功能评价量表(standardized swallowing assessment,SSA)、软式喉内窥镜吞咽功能检查(flexible endoscopic examination of swallowing,FEES)结合改良误侵误吸评分(MPAS评分)及整体疗效。结果 治疗2周后,两组患者的吞咽功能均有改善,但观察组的MDADI各范畴评分均优于对照组(P<0.001),MPT(7.19±1.31 s)优于对照组(4.29±0.88 s)(P<0.001),SSA(19.25±1.12分)优于对照组(21.20±2.55分)(P<0.05),FEES检查结合MPAS评分(1.75±0.85分)优于对照组(2.70±1.34分)(P<0.001),并且整体疗效(18,90.00%)优于对照组(12,60.00%)(P<0.001)。结论 早期应用主动呼吸循环技术结合吞咽训练相对于单纯吞咽功能训练可以较大程度的改善喉部切除术后患者吞咽功能,降低误吸发生率。

Objective To investigate the effect of early active cycle breathing technique(ACBT) on aspiration in patients with dysphagia after partial laryngectomy.Methods A total of 40 patients with laryngeal cancer with dysphagia who were hospitalized in the Department of Otorhinolaryngology of the Third Xiangya Hospital of Central South University in January 2019~January 2022 were selected,and the patients were randomly divided into 20 cases in the observation group and the control group by random number method,the control group was given routine swallowing function training,and the observation group was combined with active cycle of breathing technique(ACBT) on the basis of the control group.The two groups were treated 5 days a week,twice a day,45 minutes each for 2 weeks.The M.D.Anderson Dysphagia Inventory(MDADI),maximum phonation time(MPT),and Standardized Swallowing Assessment(SSA),flexible endoscopic examination of swallowing(FEES) combined with modified invasion and aspiration score(MPAS score) and overall clinical efficacy before and after treatment were compoued between the two groups.Results After 2 weeks of treatment,the swallowing function of both groups improved,but the MDADI scores in the observation group were better than those of in the control group in all categories(P<0.001),MPT(7.19±1.31) was better than that of the control group(4.29±0.88)(=9.436,P<0.001),SSA(19.25±1.12) was better than that of the control group(21.20±2.55)(=-2.894,P<0.05),and FEES combined with MPAS score(1.75±0.85) was better than the control group(2.70±1.34)(=-2.674,P<0.001),and the overall clinical efficacy(18,90.00%) was better than the control group(12,60.00%)(Z=-3.894,P<0.001).Conclusion Early application of active breathing and circulation technique combined with swallowing training can improve the swallowing function of patients to a greater extent and reduce the incidence of aspiration compared with swallowing function training alone.