切脉针刺联合下颏抗阻力训练对鼻咽癌放疗后吞咽障碍患者吞咽功能的影响

Effect of pulse⁃taking acupuncture combined with chin tuck against resistance training on swallowing function in nasopharyngeal carcinoma patients with dysphagia after radiotherapy

目的:探讨切脉针刺联合下颏抗阻力(CTAR)训练对鼻咽癌(NPC)放疗后吞咽障碍(SD)患者吞咽功能的影响。方法:采用随机对照研究方法,将60例NPC放疗后SD患者随机分为CTAR训练组和联合组,每组各30例。所有患者均给予常规训练,在此基础上,CTAR训练组患者给予CTAR训练干预,联合组患者给予切脉针刺联合CTAR训练干预,两组干预周期均为4周。干预前后,评价并比较两组患者的洼田饮水试验(WST)分级情况和吞咽造影检查(VFSS)评分;检测并比较两组患者的白蛋白(ALB)、前白蛋白(PA)水平,评价患者的营养状况;比较两组患者的误吸发生率;采用吞咽障碍特异性生活质量量表(SWAL-QOL)评价两组患者的生活质量。结果:(1)干预后,两组患者的WST分级情况均优于干预前(P<0.05),且联合组患者的WST分级情况优于CTAR训练组(P<0.05)。(2)干预后,两组患者的VFSS评分较干预前均明显升高(P<0.05),且联合组患者的评分高于CTAR训练组(P<0.05)。(3)干预后,两组患者的ALB、PA水平较干预前均明显升高(P<0.05),且联合组患者的ALB、PA水平高于CTAR训练组(P<0.05)。(4)在干预4周内,联合组患者的误吸发生率为3.33%,CTAR训练组患者的误吸发生率为26.67%,联合组患者的误吸发生率明显低于CTAR训练组(P<0.05)。(5)干预后,两组患者的SWAL-QOL评分较干预前均明显升高(P<0.05),且联合组患者的评分高于CTAR训练组(P<0.05)。结论:切脉针刺联合CTAR训练干预NPC放疗后SD患者,可明显改善患者的吞咽功能和营养状况,有效降低误吸发生率,提高患者的生活质量。

Objective:To investigate the effect of pulse-taking acupuncture combined with chin tuck against resistance(CTAR)training on swallowing function in nasopharyngeal carcinoma(NPC)patients with swallowing disorder(SD)after radiotherapy.Methods:A randomized controlled method was applied.Sixty NPC patients with SD after radiotherapy were randomly divided into the CTAR training group and combination group,30 cases in each group.All the patients were treated with routine training.Based on above,the patients in the CTAR training group were treated with CTAR training,and the patients in the combination group were treated with pulse-taking acupuncture combined with CTAR training.The intervention period of both groups was 4 weeks.Before and after intervention,the water swallowing test(WST)grading and the videofluoroscopic swallowing study(VFSS)score of the two groups were evaluated and compared;the levels of albumin(ALB)and prealbumin(PA)of the two groups were detected and compared in order to evaluate the nutritional status of the patients;the incidence of aspiration was compared between the two groups;the swallowing-quality of life(SWAL-QOL)was used to evaluate the life quality of the patients in the two groups.Results:①After intervention,the WST grading in both groups were better than that before intervention(P<0.05),and the WST grading in the combination group was superior to the CTAR training group(P<0.05).②After intervention,the VFSS scores in both groups were significantly increased compared with those before intervention(P<0.05),and the score of the combination group was higher than that of the CTAR training group(P<0.05).③After intervention,the levels of ALB and PA in both groups were significantly increased compared with those before intervention(P<0.05),and the levels of ALB and PA in the combination group were higher than those in the CTAR training group(P<0.05).④In the 4 weeks of intervention,the incidence of aspiration was 3.33%in the combination group and 26.67%in the CTAR training group,and the incidence of aspiration in the combination group was obviously lower than that in the CTAR training group(P<0.05).⑤After intervention,the SWAL-QOL scores in both groups were significantly increased compared with those before intervention(P<0.05),and the score of the combination group was higher than that of the CTAR training group(P<0.05).Conclusion:Pulse-taking acupuncture combined with CTAR training can significantly improve the swallowing function and nutritional status in NPC patients with SD after radiotherapy,effectively reduce the incidence of aspiration,and enhance the life quality of the patients.