摘要
目的在短期观察下,探究间歇性置管注食对鼻咽癌放疗后吞咽障碍患者生存质量的影响。方法选择2022年7月至2025年5月就诊于中山大学附属第三医院康复医学科的鼻咽癌放疗后吞咽功能障碍患者,就诊时采用持续性留置鼻胃管注食,且经评估可实现间歇性置管注食。入组后选取尚未拔除鼻胃管前(T_(0))、采用间歇性置管注食后第3天(T_(1))和第7天(T_(2))3个时间点,采用功能性经口摄食量表(FOIS)评估患者的吞咽障碍严重程度,并使用吞咽生存质量量表中文版(SWAL-QOL)进行问卷调查和评分。观察患者在3个测评时间点的吞咽生存质量变化,并根据患者年龄、性别和吞咽障碍严重程度进行分组分析,比较不同个体特征患者的生存质量差异和变化情况。结果在3个测评时间点,患者的FOIS分级差异无统计学意义(P>0.05)。在吞咽生存质量方面,心理负担、吞咽症状、社会交往、疲劳睡眠4个维度的评分差异有统计学意义(均P<0.05)。进一步两两比较显示,在心理负担、社会交往、疲劳睡眠3个维度,T_(0)与T_(1)、T_(0)与T_(2)的评分差异有统计学意义(均P<0.0167);在吞咽症状维度,T_(0)与T_(1)、T_(0)与T_(2)、T_(1)与T_(2)的评分差异均有统计学意义(均P<0.0167)。进食时间、食物选择、语言交流、进食恐惧、心理健康5个维度在3个测评时间点的评分差异无统计学意义。进一步分别对年龄、性别、FOIS分级进行分组分析,结果显示各维度评分中,分组与时间的交互效应无统计学意义(P>0.05);在心理负担、吞咽症状、社会交往、疲劳睡眠4个维度的评分中,时间效应有统计学意义(P<0.001),评分随时间上升。在性别分组中,吞咽症状、心理健康2个维度的评分,组间效应有统计学意义(P=0.035、0.011),男性组评分高于女性组;在年龄、FOIS分级的分组分析中,组间效应无统计学意义(P>0.05)。结论短期观察显示,鼻咽癌放疗后吞咽障碍患者在两种注食方式下的生存质量存在差异,间歇性置管注食方式可提高患者的生存质量。
Objective To explore the impact of intermittent nasogastric tube feeding on the quality of life of patients with dysphagia after radiotherapy for nasopharyngeal carcinoma in the short term.Methods Patients with dysphagia after radiotherapy for nasopharyngeal carcinoma who visited the Department of Rehabilitation Medicine of the Third Affiliated Hospital of Sun Yat-sen University from July 2022 to May 2025 were selected.At the time of visit,they were fed through a continuously indwelling nasogastric tube and were evaluated as suitable for intermittent nasogastric tube feeding.Three time points were selected for assessment:before the nasogastric tube was removed(T_(0)),the third day after intermittent nasogastric tube feeding(T_(1)),and the seventh day after intermittent nasogastric tube feeding(T_(2)).The Functional Oral Intake Scale(FOIS)was used to assess the severity of dysphagia,and the Chinese version of the Swallowing Quality of Life Scale(SWAL-QOL)was used for questionnaire survey and scoring.Changes in the quality of life related to swallowing at the three assessment time points were observed,and stratified analysis was conducted based on age,gender,and severity of dysphagia to compare the differences and changes in the quality of life of patients with different individual characteristics.Results There was no statistically significant difference in FOIS grades among the three assessment time points(P>0.05).In terms of the quality of life related to swallowing,there were statistically significant differences in the scores of the four dimensions of psychological burden,swallowing symptoms,social interaction,and fatigue and sleep(all P<0.05).Further pairwise comparisons showed that in the dimensions of psychological burden,social interaction,and fatigue and sleep,the differences in scores between T_(0)and T_(1),and between T_(0)and T_(2)were statistically significant(all P<0.0167);in the dimension of swallowing symptoms,the differences in scores between T_(0)and T_(1),between T_(0)and T_(2),and between T_(1)and T_(2)were all statistically significant(all P<0.0167).There were no statistically significant differences in the scores of the five dimensions of eating time,food choice,language communication,fear of eating,and mental health among the three assessment time points.Further subgroup analyses were conducted based on age,gender,and FOIS grades.The results showed that there was no statistically significant interaction effect between subgroup and time in the scores of each dimension(P>0.05);in the four dimensions of psychological burden,swallowing symptoms,social interaction,and fatigue and sleep,the time effect was statistically significant(P<0.001),and the scores increased over time.In the gender subgroup analysis,the scores in the dimensions of swallowing symptoms and mental health were significantly different between the groups(P=0.035,0.011),with higher scores in the male group than in the female group;in the subgroup analyses based on age and FOIS grades,there was no statistically significant group effect(P>0.05).Conclusion Short-term observation shows that there are differences in the quality of life among patients with dysphagia after radiotherapy for nasopharyngeal carcinoma under the two feeding methods,and intermittent nasogastric tube feeding can improve the quality of life of patients.
作者
武惠香
周海彤
陈华玉
谢纯青
窦祖林
丘卫红
WU Huixiang;ZHOU Haitong;CHEN Huayu;XIE Chunqing;DOU Zulin;QIU Weihong(Department of Rehabilitation,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Hearing and Speech Science,Guangzhou Xinhua University,Guangzhou 510520,China;Department of Otolaryngology,Foshan Fosun Chancheng Hospital,Foshan 528000,China)
出处
《新医学》
2025年第8期739-747,共9页
Journal of New Medicine
基金
国家重点研发计划(2020YFC2004201)
广东省重点建设学科科研能力提升项目(自然科学类)(2024ZDJS128)。
关键词
吞咽障碍
生存质量
持续性留置鼻胃管
间歇性置管
Dysphagia
Quality of life
Persistent nasogastric tube placement
Intermittent tube placement
