间歇经口至食管管饲对鼻咽癌放疗后迟发性吞咽障碍的影响

Intermittent feeding through an oral to esophageal tube is best for patients with a late-onset swallowing disorder after radiotherapy

目的观察间歇经口至食管管饲(IOE)对鼻咽癌放疗后迟发性吞咽障碍的影响。方法选取鼻咽癌放疗后迟发性吞咽障碍患者56例,按照随机数字表法将其分为对照组和观察组,每组28例。所有患者均接受常规治疗,在此基础上对照组和观察组分别采用留置鼻胃管(NGT)与IOE给予肠内营养支持。入院24 h和治疗15 d后,对2组患者的营养状况进行比较,采用患者健康问卷-9(PHQ-9)、功能性经口摄食量表(FOIS)、渗漏-误吸量表(PAS)、吞咽障碍特异性生活质量量表(SWAL-QOL)对2组患者的抑郁情绪、经口摄食能力、渗漏及误吸情况、生活质量进行评定。入院后第3日起,记录患者的日均喂养量。结果治疗15 d后,对照组血清白蛋白[(35.12±1.08)g/L]、血清总蛋白[(56.54±4.17)g/L]、血清前白蛋白水平[(0.17±0.05)g/L]和SWAL-QOL评分[(47.56±5.72)分]改善(P<0.05),观察组血清白蛋白[(35.91±1.37)g/L]、血红蛋白[(117.43±9.46)g/L]、血清总蛋白[(59.12±3.68)g/L]、血清前白蛋白[(0.20±0.04)g/L]水平、BMI[(21.51±1.07)kg/m^(2)]、SWAL-QOL评分[(58.14±4.91)分]改善(P<0.05),存在抑郁情绪的人数少(P<0.05)。与对照组治疗15 d后比较,观察组患者血清白蛋白、血红蛋白、血清总蛋白、血清前白蛋白水平、BMI、SWAL-QOL评分改善优异(P<0.05),存在抑郁情绪的人数明显较少(P<0.05)。入院第4日起,观察组的实际喂养量占目标喂养量的百分比显著高于对照组(P<0.05)。结论相比于NGT,IOE能更好地改善鼻咽癌放疗后迟发性吞咽障碍患者的营养状况、抑郁情绪和生活质量,且不良事件发生率较低。

Objective To observe the clinical efficacy of intermittent feeding through an oral to esophageal(IOE)tube for persons with a late-onset swallowing disorder after radiotherapy for nasopharyngeal carcinoma.Methods Fifty-six patients with late-onset swallowing difficulties after radiotherapy for nasopharyngeal carcinoma were divided at random into an observation group and a control group,each of 28.In addition to conventional therapy,the controls were fed through an indwelling nasogastric tube(NGT)while an IOE tube was used in the observation group.The nutritional status of the two groups was compared after 20 hours and after 15 days of treatment.Depression,oral feeding ability,leakage and aspiration,and life quality were evaluated using patient health questionnaire-9(PHQ-9),a functional oral feeding scale(FOIS),a leakage-aspiration scale(PAS),and a swallowing-quality of life(SWAL-QOL)evaluation.From the 3rd day after admission the daily amount fed was recorded.Results At admission there were no significant differences between the two groups.After 15 days,however,there was significantly greater improvement observed in the average serum albumin,hemoglobin,serum total protein,serum prealbumin level,body mass index(BMI)and SWAL-QOL score of the experimental group compared to the control group,with significantly fewer members suffering from depression.From the 4th day after admission the observation group′s members ate a significantly larger proportion of the target feeding amount.Conclusion IOE feeding can improve the nutritional status,psychological status,and life quality of persons with a late-onset swallowing disorder more effectively than NGT feeding,with a lower incidence of adverse events.