吞咽功能训练配合心理疏导在头颈部肿瘤放疗患者口腔黏膜炎干预中的应用

Application of Swallowing Function Training Combined with Psychological Counseling in the Intervention of Oral Mucositis in Patients with Head-Neck Tumor Radiotherapy

目的研究吞咽功能训练配合心理疏导在头颈部肿瘤放疗患者口腔粘膜炎干预中的应用。方法将湖北省襄阳市中心医院2016年6月—2018年6月间收治的头颈部肿瘤并接受放射治疗的144例患者随机分为观察组(吞咽功能训练+心理疏导,n=72)与对照组(常规护理,n=72),分别于干预3个月后,观察两组干预效果。结果经干预后,两组焦虑自评量表(SAS)及抑郁自评量表(SDS)得分均较治疗前显著降低(P<0.05),且观察组经干预后SAS及SDS量表得分更低(P<0.05);两组放疗前2周、放疗结束1周及3个月后三个时间点,组内标准吞咽功能评价量表(SSA)得分差异有统计学意义(P<0.05),且观察组放疗结束1周后与3个月后,SSA量表得分均显著高于对照组(P<0.05);观察组放疗后出现2级以上口腔疼痛的患者比例显著低于对照组(P<0.05);观察组生活质量测定量表(QLQ-C30)中生理、心理、独立性、社会关系及环境领域及总得分均显著高于对照组(P<0.05)。结论心理疏导联合吞咽功能训练能有效缓解头颈部肿瘤患者焦虑抑郁情绪,降低口腔黏膜炎发生率及口腔疼痛程度,还可减轻放疗对其吞咽功能造成的影响,提高其生活质量。

Objective To study the application of swallowing function training combined with psychological counseling in the intervention of oral mucositis in patients with head-neck tumor radiotherapy.Methods A total of 144 patients with headneck tumors who underwent radiotherapy from June 2016 to June 2018 in the hospital were randomly divided into observation group(swallowing function training+psychological counseling,n=72)and control group(conventional nursing,n=72).The intervention effects in the two groups were observed after 3 months of intervention.Results After intervention,the scores of selfrating anxiety scale(SAS)and self-rating depression scale(SDS)in the two groups were significantly lower than those before treatment(P<0.05),and the scores of SAS and SDS after intervention were lower in observation group(P<0.05).There was a significant difference in the score of standard swallowing function assessment(SSA)between the two groups at 2 w before radiotherapy,at 1 w after the end of radiotherapy and at 3 months after the end of radiotherapy(P<0.05),and the score of SSA scale at 1 w and 3 months after the end of radiotherapy in observation group was significantly higher than that in control group(P<0.05).The proportion of patients with oral pain more than grade 2 after radiotherapy in observation group was significantly lower than that in control group(P<0.05).The scores of fields of physiology,psychology,independence,social relations and environment and the total score of quality of life measurement scale(QLQ-C30)in observation group after radiotherapy were significantly higher than those in control group(P<0.05).Conclusion Psychological counseling combined with swallowing function training can effectively relieve anxiety and depression in patients with head-neck tumors,reduce the incidence rate of oral mucositis and degree of oral pain,and reduce the effects of radiotherapy on their swallowing function,and improve the quality of life.