不同吞咽训练方案对头颈部肿瘤放疗患者吞咽功能影响的网状Meta分析

Network meta-analysis of effect of different swallowing training programmes on swallowing function in patients undergoing radiotherapy for head and neck cancer

目的使用网状meta分析评价不同吞咽训练方案对头颈部肿瘤放疗患者吞咽功能的影响。方法计算机检索建库至2023年3月31日知网、万方、维普、Sinomed、Pubmed、Embase、EBSCO、Web of Science及Cochrane Library数据库中有关吞咽功能训练对头颈部肿瘤放疗患者吞咽功能影响的随机对照试验,并追溯已发表系统评价及meta分析中的纳入文献。由2名研究人员独立筛选文献、提取资料及质量评价,并采用Stata 16.0软件进行网状meta分析。结果纳入19篇文献,共1160例研究对象,干预措施采用包括由舌、唇、下颌、咽喉部动作范围练习、发音训练、Masako训练、门德尔松吞咽法、用力吞咽法、舌抗阻训练、声门上/超声门上吞咽训练、Shaker训练和CTAR训练9种吞咽功能训练方式组合成的不同吞咽训练方案。网状meta分析结果显示,与常规护理相比,采用不同吞咽训练方案可改善患者的吞咽功能,其中以舌、唇、下颌、咽喉部动作范围练习+Shaker训练和舌、唇、下颌、咽喉部动作范围练习+Mendelsohn吞咽法+用力吞咽+声门上/超声门上训练效果最佳。结论推荐临床优先将舌、唇、下颌、咽喉部动作范围练习+Shaker训练和舌、唇、下颌、咽喉部动作范围练习+Mendelsohn吞咽法+用力吞咽+声门上/超声门上训练作为改善患者吞咽障碍的最优吞咽训练方案。

Objective To evaluate the effects of nine swallowing training protocols on swallowing function in patients undergoing radiotherapy for head and neck tumors using reticulated meta-analysis.Methods Randomized controlled trials on the effects of swallowing function training on swallowing function in patients undergoing radiotherapy for head and neck tumors in the CNKI,Wanfang,VIP,sinomed,Pubmed,Embase,EBSCO,Web of Science and Cochrane Library databases from the year of establishment to March 31,2023 were searched by computer,and the included literature in the published systematic evaluations and meta-analyses were traced.The literature was independently screened,data extracted and quality evaluated by 2 researchers,and a net meta-analysis was performed using Stata 16.0 software.Results A total of 1,160 subjects from 19 publications were included in the study,using a combination of 9 swallowing training modalities including labial,lingual,jaw,neck,and mandibular range of motion exercises,articulation training,Masako maneuver,Mendelsohn maneuver,effortful swallow,tongue strengthening exercises,supraglottic swallow/super supraglottic swallow,Shaker exercise,and CTAR exercise into different swallowing training programmes.The results of network meta-analysis showed that the use of different swallowing training protocols improved the patients'swallowing function compared to conventional care,with the best results being achieved with the labial,lingual,jaw,neck,and mandibular range of motion+Shaker exercise and labial,lingual,jaw,neck,and mandibular range of motion+Mendelsohn maneuver+effortful swallow+supraglottic swallow/super supraglottic swallow.Conclusion lingual,jaw,neck,and mandibular range of motion+Shaker exercise and labial,lingual,jaw,neck,and mandibular range of motion+Mendelsohn maneuver+effortful swallow+supraglottic swallow/super supraglottic swallow are recommended as the optimal swallowing training regimen for improving dysphagia in patients.