邓益君,何杏芳,林朱梅,等.口腔颌面部肿瘤患者围手术期吞咽障碍康复实践现状的调查[J].中华物理医学与康复杂志,2025,47(12):1124-1129
扫码阅读全文
|
| 口腔颌面部肿瘤患者围手术期吞咽障碍康复实践现状的调查 |
|
| |
| DOI：10.3760/cma.j.cn421666-20250907-00767 |
| 中文关键词: 口腔癌 头颈肿瘤 围术期 吞咽障碍 现状 阻碍 |
| 英文关键词: Oral cancer Head tumors Neck tumors Dysphagia Cancer nursing |
| 基金项目:广东省医学科研基金（A2019403） |
|
| 摘要点击次数: 290 |
| 全文下载次数: 286 |
| 中文摘要: |
| 目的 探究口腔颌面部肿瘤患者围手术期吞咽障碍康复实践的现状，及其实践过程中的阻碍。 方法 采用横断面研究设计，于2024年10月至12月对33家医疗机构的60名资深口腔颌面外科护理、医疗及康复专家采用自制的《口腔颌面部肿瘤患者围手术期吞咽障碍管理实践现状及阻碍调查问卷》进行问卷调查。 结果 共回收有效问卷53份。在吞咽障碍筛查方面，98.1%的专家赞同在围手术期开展吞咽障碍筛查，并认可经过培训的护士（98.1%）、康复治疗师（81.1%）和经过培训的医生（71.7%）作为筛查实施者。筛查时机以拔气管套管后（100%）、术后（90.6%）、出院前（90.6%）和入院时（84.9%）为主。常用筛查工具包括（改良）洼田饮水试验（84.9%）、进食评估问卷调查工具-10（EAT-10）（62.3%）和吞唾试验（60.4%）。在吞咽障碍干预方面，96.2%的专家赞同在围手术期开展干预，其中无皮瓣修复者倾向于术后第1～5天开始干预，而有皮瓣修复者则倾向于术后第3～7天开始。吞咽康复实践过程中所遇到的阻碍中最重要的四条依次为，吞咽障碍相关人力资源缺乏［（6.74±2.84）分］、操作资质问题尚未明确［（6.38±2.98）分］、口腔术后伤口裂开和出血风险大［（6.19±2.78）分］、团队吞咽障碍相关知识和培训不足［（6.15±2.63）分］。 结论 目前，口腔颌面部肿瘤围手术期吞咽障碍的康复工作已获广泛关注，但尚未全面普及。筛查和干预的时机以及方式仍存争议，吞咽康复实践过程中所遇到的阻碍为吞咽障碍相关人力资源缺乏，操作资质问题尚未明确，口腔术后伤口裂开和出血风险大，以及团队吞咽障碍相关知识和培训不足。 |
| 英文摘要: |
| Objective To explore the current status of perioperative dysphagia rehabilitation practices for patients with oral and maxillofacial tumors, and the barriers in their implementation. Methods This was a cross-sectional study of 60 senior oral and maxillofacial nursing, medical and rehabilitation specialists in 33 Chinese healthcare institutions. They were surveyed using a self-designed questionnaire. Results Fifty-three valid responses were obtained. More than 98% of those responding endorsed perioperative screening by either trained nurses (98.1%), rehabilitation therapists (81.1%) or trained physicians (71.7%). After tracheostomy decannulation (100%), postoperatively (90.6%), prior to discharge (90.6%), and on admission (84.9%) were endorsed as the best times for dysphagia screening. The (modified) water drinking test (84.9%), the EAT-10 Eating Assessment Questionnaire (62.3%), and swallowing tests (60.4%) were mentioned as the screening tools most commonly used. As for dysphagia intervention, 96.2% of experts agreed on perioperative implementation. For patients without flap reconstruction, it was suggested to initiate the intervention 1 to 5 days postoperatively, while for those with flap reconstruction, it could begin 3 to 7 days after the operation. A lack of personnel specializing in dysphagia was most often mentioned as the greatest barrier in swallowing rehabilitation practice (by 6.74±2.84), followed by unclear qualifications (6.38±2.98), the high risk of wound dehiscence and bleeding following oral surgery (6.19±2.78), and inadequate team knowledge and training regarding dysphagia (6.15±2.63). Conclusions Perioperative swallowing rehabilitation for patients with oral or maxillofacial tumors remains uncommon. The optimal timing and the best screening and intervention methods remain contentious. The primary barriers encountered in dysphagia rehabilitation practice are insufficient human resources specialized in dysphagia, unclear qualifications, the high risk of wound dehiscence and bleeding following oral surgery, and inadequate team knowledge and training concerning dysphagia. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|