叙事心理疗法在喉癌外科治疗后吞咽障碍患者营养管理中的应用

Application of narrative psychotherapy to nutritional management of patients with swallowing disorders after surgical treatment of laryngeal cancer

目的探讨叙事心理疗法在喉癌外科治疗后吞咽障碍患者营养管理中的应用价值。方法采用前瞻性随机对照试验,纳入2021年3月至2023年2月在医院诊治的120例喉癌术后吞咽障碍患者,采用随机双盲法将患者分为试验组和对照组,均60例。两组患者均开展吞咽功能康复训练,对照组同时接受膳食营养干预,试验组在对照组基础上采用叙事心理疗法干预。干预8周后评估干预效果,比较两组干预前后营养指标[白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)]、心理弹性[心理弹性量表简表(RS-14)]、吞咽功能[标准吞咽功能评定量表(SSA)]、吞咽相关生活质量[吞咽障碍特异性生活质量量表(SWAL-QOL)]及并发症。结果干预后,两组血清ALB、PA、TRF水平相比干预前升高,试验组ALB、PA、TRF水平(41.33±4.24)g/L、(313.44±27.35)mg/L、(2.53±0.48)g/L高于对照组(37.35±4.52)g/L、(282.62±25.83)mg/L、(2.16±0.44)g/L(P<0.05);干预后,两组RS-14、SWAL-QOL评分相比干预前升高,SSA评分相比干预前降低,试验组RS-14、SWAL-QOL评分高于对照组,SSA评分低于对照组(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论喉癌外科治疗后吞咽障碍患者营养管理期间接受叙事心理疗法,能显著提高心理弹性,更好地改善营养状态,促进吞咽功能恢复,提高生活质量。

Objective To explore the application value of narrative psychotherapy to nutritional management of patients with swallowing disorders after surgical treatment of laryngeal cancer.Methods This was a prospective randomized controlled trial involving 120 patients with postoperative dysphagia of laryngeal cancer from March 2021 to February 2023.The patients were randomly divided into the experimental group and control group using a double-blind method,with 60 patients in each group.Both groups of patients underwent swallowing function rehabilitation training,while those in the control group received dietary and nutritional intervention.Patients in the experimental group received narrative psychotherapy intervention plus dietary and nutritional intervention.The intervention effect was evaluated at 8 weeks of intervention.The nutritional indicators,including the albumin(ALB),prealbumin(PA),and transferrin(TRF);psychological resilience,including the the 14-item resilience scale(RS-14)score;swallowing function,including the standard swallowing assessment scale(SSA);swallowing-related quality of life,including the swallowing disorder specific quality of life scale(SWAL-QOL)score;and complications were compared between the two groups before and after intervention.Results After intervention,the serum levels of ALB([41.33±4.24]g/L VS[37.35±4.52]g/L),PA([313.44±27.35]mg/L VS[282.62±25.83]mg/L),and TRF([2.53±0.48]g/L VS[2.16±0.44]g/L)in the experimental group were significantly higher than those of the control group(P<0.05).After intervention,the RS-14 and SWAL-QOL scores of the two groups increased compared to before intervention,while the SSA score decreased compared to before intervention.The experimental group had significantly higher RS-14 and SWAL-QOL scores than the control group,while the SSA score was significantly lower than the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Narrative psychotherapy during nutritional management for patients with swallowing disorders after surgical treatment of laryngeal cancer can significantly improve their psychological resilience,nutritional status,swallowing function recovery,and quality of life.