Department of Rehabilitation, Osaka International Cancer Institute, Osaka City, Japan. 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan; Swallowing Center, Osaka University Hospital, Osaka City, Japan. 2-15, Yamadaoka, Suita city, Osaka, 554-0871, Japan.
Department of Rehabilitation, Osaka International Cancer Institute, Osaka City, Japan. 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan.
Auris Nasus Larynx. 2023 Oct;50(5):757-764. doi: 10.1016/j.anl.2023.01.007. Epub 2023 Feb 11.
Head and neck cancer (HNC) treatment causes dysphagia, which may lead to aspiration pneumonia (AP). Thickened fluids are widely used to prevent aspiration in patients with dysphagia; however, there is little evidence that they can prevent AP. This study aimed to clarify the differences between restriction of oral intake of fluids (R), only thickened fluids (TF), and no restriction of fluids (NR) for AP in patients with dysphagia after HNC treatment.
We retrospectively studied 654 patients with dysphagia after HNC surgery between 2012 and 2021. Of these, 255 had some restriction of fluids. The development of possible AP and administration of antibacterial drugs were used as outcomes. Multivariate linear regression and propensity score matching analyses were performed.
The mean patient age was 64 ± 13, 67 ± 11, and 68 ± 10 years, while the Dynamic Imaging Grade of Swallowing Toxicity score 3-4 was 2.8%, 27.5, and 53.3%% water in NR, TF, and R groups, respectively. AP was diagnosed or suspected after starting oral intake in 37 (9.3%), 11 patients (15.9%), and 45 (17.6%) and antibacterial drugs were administered in 11 (2.8%), 7 patients (10.1%), and 25 (9.8%) in NR, TF, and R groups, respectively. R and TF had significant negative impacts on AP.
Fluid restrictions may not reduce the risk of AP or affect the administration of antibacterial drugs. Medical staff should bear in mind that fluid restrictions do not necessarily prevent AP in patients with HNC.
头颈部癌症（HNC）治疗会导致吞咽困难，进而可能引发吸入性肺炎（AP）。浓稠的液体被广泛用于预防吞咽困难患者的吸入；然而，几乎没有证据表明它们可以预防 AP。本研究旨在阐明 HNC 治疗后吞咽困难患者限制口服摄入液体（R）、仅使用浓稠液体（TF）和不限制液体（NR）对 AP 的影响。
我们回顾性研究了 2012 年至 2021 年间 654 例 HNC 手术后吞咽困难的患者。其中 255 例患者存在某种程度的液体限制。将可能发生的 AP 发展和使用抗菌药物作为结局。进行了多变量线性回归和倾向评分匹配分析。
患者平均年龄为 64±13 岁、67±11 岁和 68±10 岁，而 NR、TF 和 R 组的动态影像学吞咽毒性评分 3-4 分别为 2.8%、27.5%和 53.3%。在开始口服摄入后，NR、TF 和 R 组分别有 37（9.3%）、11 例（15.9%）和 45 例（17.6%）患者诊断或疑似发生 AP，并且分别有 11（2.8%）、7 例（10.1%）和 25 例（9.8%）患者使用了抗菌药物。R 和 TF 对 AP 有显著的负面影响。
液体限制可能不会降低 AP 的风险或影响抗菌药物的使用。医务人员应牢记，液体限制不一定能预防 HNC 患者的 AP。
