Department of Otorhinolaryngology-Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong.
Department of Otorhinolaryngology-Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Head Neck. 2020 Jul;42(7):1491-1496. doi: 10.1002/hed.26224. Epub 2020 May 11.
The global pandemic of 2019 novel coronavirus disease (COVID-19) has tremendously altered routine medical service provision and imposed unprecedented challenges to the health care system. This impacts patients with dysphagia complications caused by head and neck cancers. As this pandemic of COVID-19 may last longer than severe acute respiratory syndrome (SARS) in 2003, a practical workflow for managing dysphagia is crucial to ensure a safe and efficient practice to patients and health care personnel. This document provides clinical practice guidelines based on available evidence to date to balance the risks of SARS-CoV-2 exposure with the risks associated with dysphagia. Critical considerations include reserving instrumental assessments for urgent cases only, optimizing the noninstrumental swallowing evaluation, appropriate use of personal protective equipment (PPE), and use of telehealth when appropriate. Despite significant limitations in clinical service provision during the pandemic of COVID-19, a safe and reasonable dysphagia care pathway can still be implemented with modifications of setup and application of newer technologies.
2019 年新型冠状病毒病（COVID-19）的全球大流行极大地改变了常规医疗服务的提供方式，并给医疗保健系统带来了前所未有的挑战。这影响了因头颈部癌症而出现吞咽困难并发症的患者。由于 COVID-19 这场大流行可能比 2003 年的严重急性呼吸综合征（SARS）持续时间更长，因此制定管理吞咽困难的实用工作流程对于确保患者和医护人员安全、高效的治疗至关重要。本文基于现有证据提供临床实践指南，以平衡 SARS-CoV-2 暴露风险与吞咽困难相关风险。关键考虑因素包括仅将仪器评估保留给紧急情况、优化非仪器吞咽评估、正确使用个人防护设备（PPE）以及在适当情况下使用远程医疗。尽管在 COVID-19 大流行期间临床服务提供受到重大限制，但仍可以通过调整设置和应用新技术来实施安全合理的吞咽困难护理途径。
