凝固粉在全腔镜食管癌根治术后并发吞咽障碍患者中的应用效果研究
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摘要
目的观察凝固粉对全腔镜食管癌根治术后并发吞咽障碍患者营养状态、近期生存质量及临床并发症的影响。方法选取2015年6月—2017年3月于河北医科大学第四医院胸外科确诊为食管癌并行全腔镜食管癌根治术后并发喉返神经损伤致吞咽障碍患者78例,采用随机数字表法将其分为试验组(40例)和对照组(38例)。患者均给予吞咽功能训练,对照组给予常规术后饮食,试验组在普通饮食的基础上加服凝固粉。于治疗前后采用标准吞咽功能评定量表(SSA)、生存质量问卷(EORTC-QLQ-C30)进行评分,测定清蛋白及血红蛋白,记录术后吸入性肺炎、便秘发生率。结果治疗2、4周后试验组SSA评分均低于对照组(P<0.05)。试验组出院1个月的总体健康状况、躯体功能、情感功能、社会功能、认知功能、角色功能评分均高于对照组,疲劳、恶心呕吐、疼痛、失眠、呼吸困难、食欲下降、便秘、腹泻、经济困难评分均低于对照组(P<0.05)。治疗4周后试验组清蛋白、血红蛋白水平均高于对照组(P<0.05)。试验组吸入性肺炎、便秘发生率均低于对照组(χ~2=3.921、4.647,P<0.05)。试验组、对照组患者治疗4周后SSA评分与总体健康状况评分均呈负相关(r=-0.805、-0.787,P<0.05)。结论在以吞咽功能训练为主的综合康复干预基础上加用凝固粉,能有效地改善全腔镜食管癌术后并发吞咽障碍患者的吞咽功能,减少并发症的发生,提高患者生活质量,促进其快速康复。
Objective To observe the effects of coagulation powder on nutritional status,quality of life(QOL),and clinical complications in patients with swallowing dysfunction after endoscopic radical surgery for esophageal cancer.Methods Seventy-eight patients were enrolled at the Fourth Hospital of Hebei Medical University from June 2015 to March 2017.All had swallowing dysfunction caused by laryngeal nerve injury associated with endoscopic radical surgery for esophageal cancer.They all received swallowing therapy and were randomly assigned postoperatively to either a routine diet(the control group,n=38) or a routine diet plus coagulation powder(the experimental group,n=40).The standardized swallowing assessment(SSA) and the EORTC Quality of Life Questionnaire-Core 30(EORTC-QLQ-C30) were administered before and after treatment.Albumin and hemoglobin were assayed and the occurrence of postoperative aspiration pneumonia and constipation was monitored.Results After 2 and 4 weeks of treatment,the SSA scores of the experimental group were significantly lower than those of the control group(P<0.05).The scores of general health,physical function,emotional function,social function,cognitive function and role function in the experimental group after one month of discharge were higher than those in the control group,and the scores of fatigue, nausea and vomiting,pain,insomnia,dyspnea,loss of appetite,constipation,diarrhea and economic difficulty were lower than those in the control group(P<0.05). After 4 weeks of treatment,the albumin and hemoglobin levels of the experimental group were significantly higher than that of the control group(P<0.05).The incidence of aspiration pneumonia and constipation in the experimental group was lower than that in the control group(χ~2=3.921,χ~2=4.647,P<0.05).SSA and overall health status scores were negatively correlated in both the experimental group and control group at 4 weeks after treatment(r=-0.805,r=-0.787,P<0.05).Conclusion Including coagulation powder in a comprehensive rehabilitation intervention improved swallowing dysfunction,reduced complications,improved QOL,and promoted patient recovery after endoscopic radical surgery for esophageal cancer.
Objective To observe the effects of coagulation powder on nutritional status,quality of life(QOL),and clinical complications in patients with swallowing dysfunction after endoscopic radical surgery for esophageal cancer.Methods Seventy-eight patients were enrolled at the Fourth Hospital of Hebei Medical University from June 2015 to March 2017.All had swallowing dysfunction caused by laryngeal nerve injury associated with endoscopic radical surgery for esophageal cancer.They all received swallowing therapy and were randomly assigned postoperatively to either a routine diet(the control group,n=38) or a routine diet plus coagulation powder(the experimental group,n=40).The standardized swallowing assessment(SSA) and the EORTC Quality of Life Questionnaire-Core 30(EORTC-QLQ-C30) were administered before and after treatment.Albumin and hemoglobin were assayed and the occurrence of postoperative aspiration pneumonia and constipation was monitored.Results After 2 and 4 weeks of treatment,the SSA scores of the experimental group were significantly lower than those of the control group(P<0.05).The scores of general health,physical function,emotional function,social function,cognitive function and role function in the experimental group after one month of discharge were higher than those in the control group,and the scores of fatigue, nausea and vomiting,pain,insomnia,dyspnea,loss of appetite,constipation,diarrhea and economic difficulty were lower than those in the control group(P<0.05). After 4 weeks of treatment,the albumin and hemoglobin levels of the experimental group were significantly higher than that of the control group(P<0.05).The incidence of aspiration pneumonia and constipation in the experimental group was lower than that in the control group(χ~2=3.921,χ~2=4.647,P<0.05).SSA and overall health status scores were negatively correlated in both the experimental group and control group at 4 weeks after treatment(r=-0.805,r=-0.787,P<0.05).Conclusion Including coagulation powder in a comprehensive rehabilitation intervention improved swallowing dysfunction,reduced complications,improved QOL,and promoted patient recovery after endoscopic radical surgery for esophageal cancer.
引文
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[4]袁勇,胡杨,伍伫,等.分层吻合在胸腹腔镜食管癌切除术中的应用[J].中华胸心血管外科杂志,2016,32(8):470-473.DOI:10.3760/cma.j.issn.1001-4497.2016.08.007.YUAN Y,HU Y,WU Z,et al.Double layered anastomosis in thoraeoseopie and laparoscopic esophagectomy[J].Chinese Journal of Thoracic and Cardiovascular Surgery,2016,32(8):470-473.DOI:10.3760/cma.j.issn.1001-4497.2016.08.007.
[5]毛友生,赫捷,薛奇,等.全国食管癌规范化诊治推广之路[J].中华胃肠外科杂志,2013,16(9):801-804.DOI:10.3760/cma.j.issn.1671-0274.2013.09.001.MAO Y S,HE J,XUE Q,et al.Nationwide speaking tour of standardized diagnosis and treatment for esophageal cancer[J].Chinese Journal of Gastrointestinal Surgery,2013,16(9):801-804.DOI:10.3760/cma.j.issn.1671-0274.2013.09.001.
[6]伍少玲,马超,黄粉燕,等.标准吞咽功能评定量表的临床应用研究[J].中华物理医学与康复杂志,2008,30(6):396-399.DOI:10.3321/j.issn:0254-1424.2008.06.010.WU S L,MA C,HUANG F Y,et al.Clinical application of the standardized swallowing assessment[J].Chinese Journal of Physical Medicine and Rehabilitation,2008,30(6):396-399.DOI:10.3321/j.issn:0254-1424.2008.06.010.
[7]SNYDER C F,BLACKFORD A L,SUSSMAN J,et al.Identifying changes in scores on the EORTC-QLQ-C30 representing a change in patients'supportive care needs[J].Qual Life Res,2015,24(5):1207-1216.DOI:10.1007/s11136-014-0853-y.
[8]卫生部卫生统计信息中心,全国肿瘤防治研究办公室.中国恶性肿瘤危险因素研究[M].北京:中国协和医科大学出版社,2003:235.
[9]任国琴,苏纯音,薛永生,等.食管癌患者生存质量的研究现状[J].中华护理杂志,2008,43(2):161-163.DOI:10.3761/j.issn.0254-1769.2008.02.028.REN G Q,SU C Y,XUE Y S,et al.Research status of quality of life for patients with esophageal cancer[J].Chinese Journal of Nursing,2008,43(2):161-163.DOI:10.3761/j.issn.0254-1769.2008.02.028.
[10]VIKLUND P,WENGSTR?M Y,ROUVELAS I,et al.Quality of life and persisting symptoms after oesophageal cancer surgery[J].Eur J Cancer,2006,42(10):1407-1414.DOI:10.1016/j.ejca.2006.02.005.
[11]杨军,吕必宏,朱卫东,等.胸腔镜和腹腔镜联合手术与开放手术治疗食管癌的回顾性队列研究[J].中华外科杂志,2015,53(5):378-381.DOI:10.3760/cma.j.issn.0529-5815.2015.05.013.YANG J,LYU B H,ZHU W D,et al.A retrospective cohort comparison of esophageal carcinoma between thoracoscopic and laparoscopic esophagectomy and open esophagectomy[J].Chinese Journal of Surgery,2015,53(5):378-381.DOI:10.3760/cma.j.issn.0529-5815.2015.05.013.
[12]张真铭,宋宇,高永山,等.胸腹腔镜联合食管癌切除350例临床分析[J].中华胃肠外科杂志,2015,18(1):37-40.DOI:10.3760/cma.j.issn.1671-0274.2015.01.010.ZHANG Z M,SONG Y,GAO Y S,et al.Thoracoscopic and laparoscopic esophagectomy in the treatment of esophageal carcinoma:clinical analysis of 350 cases[J].Chinese Journal of Gastrointestinal S u r g e r y,2 0 1 5,1 8(1):3 7-4 0.D O I:1 0.3 7 6 0/c m a.j.issn.1671-0274.2015.01.010.
[13]UDAGAWA H,UENO M,HARUTA S,et al.Re-evaluation of the role of thoracoscopic esophagectomy as a Japanese-style radical surgery[J].Esophagus,2017,14(2):165-170.DOI:10.1007/s10388-016-0567-z.
[14]蒋桂花,林强,周素萍,等,凝固粉在脑卒中吞咽障碍患者康复护理中的效果研究[J].护士进修杂志,2013,28(11):969-971.DOI:10.3969/j.issn.1002-6975.2013.11.003.JIANG G H,LIN Q,ZHOU S P,et al.Nursing intervention study for the effects of recovery nursing for dysphagia patients after stroke by solidificationg power[J].Journal of Nursing Training,2013,28(11):969-971.DOI:10.3969/j.issn.1002-6975.2013.11.003.
[15]叶惠坚,吴玉玲,洪莉萍.食物凝固粉在脑卒中吞咽障碍病人中的应用[J].护理研究,2013,27(10):917-918.DOI:10.3969/j.issn.1009-6493.2013.10.024.YE H J,WU Y L,HONG L P.Application of food solidified powder in stroke patients with dysphagia[J].Chinese Nursing Research,2013,27(10):917-918.DOI:10.3969/j.issn.1009-6493.2013.10.024.
[16]袁智敏,黄利荣,陈紫玲.凝固剂加肠内营养制剂在脑卒中吞咽障碍患者康复中的应用[J].中国临床康复,2003,7(28):3834-3835.DOI:10.3321/j.issn:1673-8225.2003.28.022.YUAN Z M,HUANG L R,CHEN Z L.Coagulant and enteral nutrition agent in the rehabilitation of deglutition disorders for patients with acute stroke[J].Chinese Journal of Clinical Rehabilitation,2003,7(28):3834-3835.DOI:10.3321/j.issn:1673-8225.2003.28.022.
[17]邝景云,彭伟英,潘瑞明.食物凝固粉在脑卒中吞咽障碍患者中的应用及护理[J].中国实用神经疾病杂志,2009,12(22):51-52.DOI:10.3969/j.issn.1673-5110.2009.22.030.KUANG J Y,PENG W Y,PAN R M.Application and nursing of food coagulant in patients with dysphagia after stroke[J].Chinese Journal of Practical Nervous Diseases,2009,12(22):51-52.DOI:10.3969/j.issn.1673-5110.2009.22.030.
[18]马明全,姜宏景,唐鹏,等.胸腔镜微创与开放食管癌根治术围手术期并发症和淋巴结清扫情况的回顾性比较[J].中华胸心血管外科杂志,2015,31(5):260-263.DOI:10.3760/cma.j.issn.1001-4497.2015.05.002.MA M Q,JIANG H J,TANG P,et al.Retrospective comparative study of preoperative complications and lymphadenectomy between thoracoscopic esophagectomy and open procedure[J].Chinese Journal of Thoracic and Cardiovascular Surgery,2015,31(5):260-263.DOI:10.3760/cma.j.issn.1001-4497.2015.05.002.
[19]邝景云,彭伟英,李美琼,等.吞咽障碍筛查对降低急性脑卒中患者吸入性肺炎的作用[J].内科护理,2011,26(9):25-27.DOI:10.3870/hlxzz.2011.09.025.KUANG J Y,PENG W Y,LI M Q,et al.Effect of deglutition disorder test on aspiration pneumonia prevention in acute stroke patients[J].Journal of Nursing Science,2011,26(9):25-27.DOI:10.3870/hlxzz.2011.09.025.
[20]窦祖林.吞咽障碍评估与治疗[M].北京:人民卫生出版社,2009:11,41-44,99-100.DOU Z L.Evaluation and treatment of dysphagia[M].Beijing:People's Medical Publishing House,2009:11,41-44,99-100.
[21]宋振华,赭明,马素萍,等.综合康复治疗脑卒中合并假性延髓麻痹患者吞咽障碍的疗效观察[J].中华物理医学与康复杂志,2006,28(4):255-256.DOI:10.3760/j:issn:0254-1424.2006.04.010.SONG Z H,ZHE M,MA S P,et al.Effect of comprehensive rehabilitation on dysphagia in stroke patients complicated with pseudobulbar palsy[J].Chinese Journal of Physical Medicine and Rehabilitation,2006,28(4):255-256.DOI:10.3760/j:issn:0254-1424.2006.04.010.
[2]TAKEUCHI H,KAWAKUBO H,KITAGAWA Y.Current status of minimally invasive esophagectomy for patients with esophageal cancer[J].Gen Thorac Cardiovase Surg,2013,61(9):513-521.DOI:10.1007/s11748-013-0258-9.
[3]BLOM R L,KLINKENBIJL J H,HOLLMANN M W,et al.Results of the introduction of a minimally invasive esophagectomy program in a tertiary referral center[J].J Thorac Dis,2012,4(5):467-473.DOI:10.3978/j.issn.2072-1439.2012.09.05.
[4]袁勇,胡杨,伍伫,等.分层吻合在胸腹腔镜食管癌切除术中的应用[J].中华胸心血管外科杂志,2016,32(8):470-473.DOI:10.3760/cma.j.issn.1001-4497.2016.08.007.YUAN Y,HU Y,WU Z,et al.Double layered anastomosis in thoraeoseopie and laparoscopic esophagectomy[J].Chinese Journal of Thoracic and Cardiovascular Surgery,2016,32(8):470-473.DOI:10.3760/cma.j.issn.1001-4497.2016.08.007.
[5]毛友生,赫捷,薛奇,等.全国食管癌规范化诊治推广之路[J].中华胃肠外科杂志,2013,16(9):801-804.DOI:10.3760/cma.j.issn.1671-0274.2013.09.001.MAO Y S,HE J,XUE Q,et al.Nationwide speaking tour of standardized diagnosis and treatment for esophageal cancer[J].Chinese Journal of Gastrointestinal Surgery,2013,16(9):801-804.DOI:10.3760/cma.j.issn.1671-0274.2013.09.001.
[6]伍少玲,马超,黄粉燕,等.标准吞咽功能评定量表的临床应用研究[J].中华物理医学与康复杂志,2008,30(6):396-399.DOI:10.3321/j.issn:0254-1424.2008.06.010.WU S L,MA C,HUANG F Y,et al.Clinical application of the standardized swallowing assessment[J].Chinese Journal of Physical Medicine and Rehabilitation,2008,30(6):396-399.DOI:10.3321/j.issn:0254-1424.2008.06.010.
[7]SNYDER C F,BLACKFORD A L,SUSSMAN J,et al.Identifying changes in scores on the EORTC-QLQ-C30 representing a change in patients'supportive care needs[J].Qual Life Res,2015,24(5):1207-1216.DOI:10.1007/s11136-014-0853-y.
[8]卫生部卫生统计信息中心,全国肿瘤防治研究办公室.中国恶性肿瘤危险因素研究[M].北京:中国协和医科大学出版社,2003:235.
[9]任国琴,苏纯音,薛永生,等.食管癌患者生存质量的研究现状[J].中华护理杂志,2008,43(2):161-163.DOI:10.3761/j.issn.0254-1769.2008.02.028.REN G Q,SU C Y,XUE Y S,et al.Research status of quality of life for patients with esophageal cancer[J].Chinese Journal of Nursing,2008,43(2):161-163.DOI:10.3761/j.issn.0254-1769.2008.02.028.
[10]VIKLUND P,WENGSTR?M Y,ROUVELAS I,et al.Quality of life and persisting symptoms after oesophageal cancer surgery[J].Eur J Cancer,2006,42(10):1407-1414.DOI:10.1016/j.ejca.2006.02.005.
[11]杨军,吕必宏,朱卫东,等.胸腔镜和腹腔镜联合手术与开放手术治疗食管癌的回顾性队列研究[J].中华外科杂志,2015,53(5):378-381.DOI:10.3760/cma.j.issn.0529-5815.2015.05.013.YANG J,LYU B H,ZHU W D,et al.A retrospective cohort comparison of esophageal carcinoma between thoracoscopic and laparoscopic esophagectomy and open esophagectomy[J].Chinese Journal of Surgery,2015,53(5):378-381.DOI:10.3760/cma.j.issn.0529-5815.2015.05.013.
[12]张真铭,宋宇,高永山,等.胸腹腔镜联合食管癌切除350例临床分析[J].中华胃肠外科杂志,2015,18(1):37-40.DOI:10.3760/cma.j.issn.1671-0274.2015.01.010.ZHANG Z M,SONG Y,GAO Y S,et al.Thoracoscopic and laparoscopic esophagectomy in the treatment of esophageal carcinoma:clinical analysis of 350 cases[J].Chinese Journal of Gastrointestinal S u r g e r y,2 0 1 5,1 8(1):3 7-4 0.D O I:1 0.3 7 6 0/c m a.j.issn.1671-0274.2015.01.010.
[13]UDAGAWA H,UENO M,HARUTA S,et al.Re-evaluation of the role of thoracoscopic esophagectomy as a Japanese-style radical surgery[J].Esophagus,2017,14(2):165-170.DOI:10.1007/s10388-016-0567-z.
[14]蒋桂花,林强,周素萍,等,凝固粉在脑卒中吞咽障碍患者康复护理中的效果研究[J].护士进修杂志,2013,28(11):969-971.DOI:10.3969/j.issn.1002-6975.2013.11.003.JIANG G H,LIN Q,ZHOU S P,et al.Nursing intervention study for the effects of recovery nursing for dysphagia patients after stroke by solidificationg power[J].Journal of Nursing Training,2013,28(11):969-971.DOI:10.3969/j.issn.1002-6975.2013.11.003.
[15]叶惠坚,吴玉玲,洪莉萍.食物凝固粉在脑卒中吞咽障碍病人中的应用[J].护理研究,2013,27(10):917-918.DOI:10.3969/j.issn.1009-6493.2013.10.024.YE H J,WU Y L,HONG L P.Application of food solidified powder in stroke patients with dysphagia[J].Chinese Nursing Research,2013,27(10):917-918.DOI:10.3969/j.issn.1009-6493.2013.10.024.
[16]袁智敏,黄利荣,陈紫玲.凝固剂加肠内营养制剂在脑卒中吞咽障碍患者康复中的应用[J].中国临床康复,2003,7(28):3834-3835.DOI:10.3321/j.issn:1673-8225.2003.28.022.YUAN Z M,HUANG L R,CHEN Z L.Coagulant and enteral nutrition agent in the rehabilitation of deglutition disorders for patients with acute stroke[J].Chinese Journal of Clinical Rehabilitation,2003,7(28):3834-3835.DOI:10.3321/j.issn:1673-8225.2003.28.022.
[17]邝景云,彭伟英,潘瑞明.食物凝固粉在脑卒中吞咽障碍患者中的应用及护理[J].中国实用神经疾病杂志,2009,12(22):51-52.DOI:10.3969/j.issn.1673-5110.2009.22.030.KUANG J Y,PENG W Y,PAN R M.Application and nursing of food coagulant in patients with dysphagia after stroke[J].Chinese Journal of Practical Nervous Diseases,2009,12(22):51-52.DOI:10.3969/j.issn.1673-5110.2009.22.030.
[18]马明全,姜宏景,唐鹏,等.胸腔镜微创与开放食管癌根治术围手术期并发症和淋巴结清扫情况的回顾性比较[J].中华胸心血管外科杂志,2015,31(5):260-263.DOI:10.3760/cma.j.issn.1001-4497.2015.05.002.MA M Q,JIANG H J,TANG P,et al.Retrospective comparative study of preoperative complications and lymphadenectomy between thoracoscopic esophagectomy and open procedure[J].Chinese Journal of Thoracic and Cardiovascular Surgery,2015,31(5):260-263.DOI:10.3760/cma.j.issn.1001-4497.2015.05.002.
[19]邝景云,彭伟英,李美琼,等.吞咽障碍筛查对降低急性脑卒中患者吸入性肺炎的作用[J].内科护理,2011,26(9):25-27.DOI:10.3870/hlxzz.2011.09.025.KUANG J Y,PENG W Y,LI M Q,et al.Effect of deglutition disorder test on aspiration pneumonia prevention in acute stroke patients[J].Journal of Nursing Science,2011,26(9):25-27.DOI:10.3870/hlxzz.2011.09.025.
[20]窦祖林.吞咽障碍评估与治疗[M].北京:人民卫生出版社,2009:11,41-44,99-100.DOU Z L.Evaluation and treatment of dysphagia[M].Beijing:People's Medical Publishing House,2009:11,41-44,99-100.
[21]宋振华,赭明,马素萍,等.综合康复治疗脑卒中合并假性延髓麻痹患者吞咽障碍的疗效观察[J].中华物理医学与康复杂志,2006,28(4):255-256.DOI:10.3760/j:issn:0254-1424.2006.04.010.SONG Z H,ZHE M,MA S P,et al.Effect of comprehensive rehabilitation on dysphagia in stroke patients complicated with pseudobulbar palsy[J].Chinese Journal of Physical Medicine and Rehabilitation,2006,28(4):255-256.DOI:10.3760/j:issn:0254-1424.2006.04.010.