快速康复外科护理模式对下咽癌患者吞咽功能及生活质量的影响

陈小英　谢常宁

[摘要] 目的 探討快速康复外科护理模式对下咽癌患者吞咽功能及生活质量的影响。 方法 选取90例下咽癌患者作为研究对象，随机分为对照组和观察组，每组各45例。对照组给予下咽癌围手术期常规护理，观察组在此基础上给予主要针对吞咽功能的规范快速康复外科护理。对比两组干预前后吞咽功能、吞咽能力康复效果、生活质量及并发症。 结果 干预后，两组洼田饮水试验评定分级比较差异明显（P<0.05）;干预前后，两组洼田饮水试验评定分级比较，差异有统计学意义（P<0.05）。干预前，对照组、观察组VFSS评分和QLQ-C30评分分别为（3.51±0.72）分、（75.42±6.38）分、（3.47±0.83）分、（76.01±6.65）分;干预后，对照组、观察组VFSS评分和QLQ-C30评分分别为（6.02±1.83）分和（83.56±8.04）分和（7.55±2.54）分和（90.23±9.75）分;与干预前比较，干预后两组VFSS评分和QLQ-C30评分均升高，差异有统计学意义（均P<0.05）;干预后，观察组VFSS评分高于对照组，差异有统计学意义（均P<0.05）。观察组临床总有效率明显高于对照组（88.89% vs. 71.11%），差异有统计学意义（P<0.05）。观察组并发症总发生率低于对照组（15.56% vs. 35.56%），差异有统计学意义（P<0.05）。 结论 与常规护理模式比较，快速康复外科护理模式可明显改善下咽癌患者吞咽功能，提高其生活质量，减少并发症发生，值得推广。

[关键词] 下咽癌;快速康复外科护理模式;吞咽功能;生活质量

[中图分类号] R473          [文献标识码] B          [文章编号] 1673-9701（2021）04-0165-04

Effect of rapid rehabilitation surgical nursing model on swallowing function and quality of life of patients with hypopharyngeal carcinoma

CHEN Xiaoying   XIE Changning

Otorhinolaryngology Head and Neck Surgery Center， Xiangya Hospital Central South University， Changsha   410008， China

[Abstract] Objective To explore the effect of rapid rehabilitation surgical nursing model on swallowing function and quality of life of patients with hypopharyngeal cancer. Methods Ninety patients with hypopharyngeal carcinoma were selected as the research objects and randomly divided into the control group and the observation group， with 45 cases in each group. The control group was given routine perioperative nursing care for hypopharyngeal cancer， and the observation group was given standard rapid rehabilitation surgical care mainly for swallowing function on this basis. The swallowing function， the rehabilitation effect of swallowing ability， quality of life， and complications were compared between the two groups before and after the intervention. Results After the intervention， there was a significant difference in the evaluation grading of the Watain drinking water test between the two groups（P<0.05）. Before and after the intervention， there were significant differences in the evaluation grading of the Watain drinking water test in the two groups， and the difference was statistically significant（both P<0.05）. Before the intervention， the VFSS score and QLQ-C30 score of the control group and the observation group were（3.51±0.72） points， （75.42±6.38） points and （3.47±0.83） points， （76.01±6.65） points， respectively. After the intervention， the VFSS score and QLQ-C30 scores were（6.02±1.83） points， （83.56±8.04） points and （7.55±2.54） points， （90.23±9.75） points， respectively. Compared with those before the intervention， the VFSS score and QLQ-C30 score of the two groups increased after the intervention， and the difference was statistically significant（P<0.05）. After the intervention， the VFSS score of the observation group was higher than that of the control group， and the difference was statistically significant（all P<0.05）. The total clinical effective rate of the observation group was significantly higher than that of the control group（88.89% vs. 71.11%）， and the difference was statistically significant（P<0.05）. The total incidence of complications in the observation group was lower than that in the control group（15.56% vs. 35.56%）， and the difference was statistically significant（P<0.05）. Conclusion Compared with the conventional nursing model， the rapid rehabilitation surgical nursing model can significantly improve the swallowing function， improve quality of life， and reduce complications in patients with hypopharyngeal cancer. It is worthy of promotion.

[Key words] Hypopharyngeal carcinoma; Rapid rehabilitation surgical nursing model; Swallowing function; Quality of life

下咽癌好發于50～70岁，是头颈部常见恶性肿瘤之一，占3%～5%，在全身恶性肿瘤中占0.8%～1.5%;近年数据显示其发病趋年轻化且稳步上升，应引起重视[1-2]。截至目前，手术治疗仍是下咽癌的主要手段，但易导致患者吞咽功能障碍，主要表现为食物咽下困难、误咽、误吸、呛咳等症状，影响患者生活质量，严重时可致患者出现窒息死亡，因此如何改善下咽癌术后吞咽功能十分重要[3]。研究表明，术后有效的护理是促进吞咽功能恢复和患者康复的关键，但对于下咽癌具体护理模式目前尚无统一标准[4]。快速康复外科护理是源自欧美国家的一种围术期新型护理模式，旨在促进术后康复、缩短住院治疗时间，最初主要应用于冠状动脉搭桥术，现已广泛应用于心胸外科、普外科、妇科、骨科及乳腺外科等领域[5-6]。但关于快速康复外科护理在下咽癌中的应用报道较少。……