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术后需鼻饲管喂养的口腔癌患者的吞咽运动学分析能否预测经口摄食量的恢复?

Can Videofluoroscopic Swallowing Kinematic Analysis Predict Recovery of Oral Intake in Postoperative Oral Cancer Patients Requiring Nasogastric Tube Feeding?

机构信息

Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo Ward, Tokyo 113-8549, Japan.

Department of Critical Care Medicine and Dentistry, Division of Medically Compromised Geriatric Dentistry, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka 238-8580, Japan.

出版信息

Int J Environ Res Public Health. 2021 Nov 16;18(22):12045. doi: 10.3390/ijerph182212045.

Abstract

This retrospective study determined the significant predictive factors for the number of days required to remove nasogastric tubes (NGTs) after surgery in patients with oral cancer (OC). In this study, patients underwent a videofluoroscopic swallowing study (VFSS) approximately 2 weeks after surgery. Videofluoroscopic images were analyzed, and variables such as swallowing and swallowing kinematics were measured. Patient characteristics, swallowing kinematics, and swallowing results were assessed using a Cox proportional hazards model. This study assessed 129 participants (66 men, 63 women, mean age: 69.0 ± 14.1 years) with nine types of cancer. The Cox proportional hazard ratio revealed that sex, body mass index before surgery, radiotherapy and/or chemotherapy, dysphagia before surgery, normalized pharyngeal constriction ratio, upper esophageal sphincter (UES) opening, and laryngeal vestibule disclosure (LVC) disorder were predictive factors for the removal of NGTs when adjusted for age. The study identified several predictive factors for the removal of NGTs and oral intake recovery in patients with OC. Regarding swallowing kinematics, UES opening is the most significant predictive factor. After surgery for OC, VFSS should be performed to assess safe eating methods and predict the recovery of oral intake and removal of the NGT.

摘要

本回顾性研究确定了口腔癌(OC)患者手术后拔除鼻胃管(NGT)所需天数的显著预测因素。在这项研究中,患者在手术后大约 2 周进行了视频透视吞咽研究(VFSS)。对视频透视图像进行分析,并测量吞咽和吞咽运动学等变量。使用 Cox 比例风险模型评估患者特征、吞咽运动学和吞咽结果。本研究评估了 129 名参与者(66 名男性,63 名女性,平均年龄:69.0±14.1 岁),他们患有九种癌症。Cox 比例风险比显示,性别、手术前的体重指数、放疗和/或化疗、手术前的吞咽困难、正常化咽缩比率、食管上括约肌(UES)开口和喉前庭暴露(LVC)障碍是调整年龄后预测 NGT 拔除的因素。该研究确定了 OC 患者拔除 NGT 和恢复口服摄入的几个预测因素。就吞咽运动学而言,UES 开口是最重要的预测因素。OC 手术后,应进行 VFSS 以评估安全的进食方法,并预测口服摄入的恢复和 NGT 的拔除。

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