头颈部癌症放疗后相关误吸的呼气肌力量训练：病例系列研究。
Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series.
机构信息
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Speech, Language, and Hearing Sciences, The University of Florida, Gainesville, Florida, U.S.A.
出版信息
Laryngoscope. 2018 May;128(5):1044-1051. doi: 10.1002/lary.26845. Epub 2017 Aug 22.
OBJECTIVE/HYPOTHESIS: Expiratory muscle strength training (EMST) is a simple, inexpensive, device-driven exercise therapy. Therapeutic potential of EMST was examined among head and neck cancer survivors with chronic radiation-associated aspiration.
STUDY DESIGN
Retrospective case series.
METHODS
Maximum expiratory pressures (MEPs) were examined among n = 64 radiation-associated aspirators (per penetration-aspiration scale score ≥ 6 on modified barium swallow). Pre-post EMST outcomes were examined in a nested subgroup of patients (n = 26) who enrolled in 8 weeks of EMST (25 repetitions, 5 days/week, 75% load). Nonparametric analyses examined effects of EMST on the primary endpoint MEPs. Secondary measures included swallowing safety (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]), perceived dysphagia (M.D. Anderson Dysphagia Inventory [MDADI]), and diet (performance status scale for head and neck cancer patients [PSSHN]).
RESULTS
Compared to sex-matched published normative data, MEPs were reduced in 91% (58 of 64) of aspirators (mean ± standard deviation: 89 ± 37). Twenty-six patients enrolled in EMST and three patients withdrew. MEPs improved on average 57% (87 ± 29 to 137 ± 44 cm H O, P < 0.001) among 23 who completed EMST. Swallowing safety (per DIGEST) improved significantly (P = 0.03). Composite MDADI scores improved post-EMST (pre-EMST: 59.9 ± 17.1, post-EMST: 62.7 ± 13.9, P = 0.13). PSSHN diet scores did not significantly change.
CONCLUSION
MEPs were reduced in chronic radiation-associated aspirators relative to normative data, suggesting that expiratory strengthening could be a novel therapeutic target to improve airway protection in this population. Similar to findings in neurogenic populations, these data also suggest improved expiratory pressure-generating capabilities after EMST and translation to functional improvements in swallowing safety in chronic radiation-associated aspirators.
LEVEL OF EVIDENCE
- Laryngoscope, 128:1044-1051, 2018.
目的/假设：呼气肌力量训练（EMST）是一种简单、廉价、设备驱动的运动疗法。研究了 EMST 在患有慢性放射性相关吸入的头颈部癌症幸存者中的治疗潜力。
研究设计
回顾性病例系列。
方法
在 n = 64 名与辐射相关的吸入者（改良钡吞咽渗透-吸入量表评分≥6）中检查最大呼气压力（MEPs）。在参加 8 周 EMST（25 次重复，每周 5 天，75%负荷）的嵌套亚组患者（n = 26）中检查了 EMST 的预-后结果。非参数分析检查了 EMST 对主要终点 MEPs 的影响。次要措施包括吞咽安全性（动态成像吞咽毒性分级[DIGEST]）、感知吞咽困难（MD 安德森吞咽障碍指数[MDADI]）和饮食（头颈部癌症患者表现状态量表[PSSHN]）。
结果
与性别匹配的已发表正常数据相比，91%（64 名中的 58 名）的吸入者的 MEPs 降低（平均±标准差：89±37）。26 名患者参加了 EMST，3 名患者退出。在 23 名完成 EMST 的患者中，MEPs 平均提高了 57%（87±29 至 137±44 cm H 2 O，P<0.001）。吞咽安全性（按 DIGEST 评估）显著改善（P=0.03）。综合 MDADI 评分在 EMST 后有所改善（EMST 前：59.9±17.1，EMST 后：62.7±13.9，P=0.13）。PSSHN 饮食评分没有显著变化。
结论
与正常数据相比，慢性放射性相关吸入者的 MEPs 降低，提示呼气强化可能是改善该人群气道保护的新治疗靶点。与神经源性人群的研究结果相似，这些数据还表明，EMST 后呼气压力生成能力提高，并转化为慢性放射性相关吸入者吞咽安全性的功能改善。
证据水平
4.喉镜，128：1044-1051，2018。
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