头颈肿瘤放疗患者吞咽功能障碍的护理评估与康复训练指导效果回顾

Nursing Assessment and Rehabilitation Training Guidance in Patients with Swallowing Dysfunction Following Radiotherapy for Head and Neck Tumors: A Review of Effectiveness

摘要: 目的：回顾性分析头颈肿瘤放疗患者吞咽功能障碍的护理评估方法及康复训练指导的临床效果，为临床护理实践提供参考依据。方法：回顾性选取新疆医科大学第三附属医院头颈综合放射治疗科2022年1月至2023年12月收治的80例头颈肿瘤放疗后出现吞咽功能障碍的患者作为研究对象，所有患者均接受系统的吞咽功能护理评估(包括临床观察、标准化量表评估、辅助检查评估)及个性化康复训练指导(包括基础训练、口腔肌肉训练、吞咽技巧训练、饮食指导)，干预周期为放疗开始至放疗结束后3个月。回顾分析患者干预前后吞咽功能分级、吞咽困难评分、营养指标及并发症发生情况的变化。结果：放疗结束当天，患者吞咽功能分级较干预前显著改善，其中重度吞咽功能障碍患者占比由干预前的37.50%降至8.75%，轻度吞咽功能障碍患者占比由22.50%升至65.00%，差异有统计学意义(P < 0.05)；患者吞咽困难评分(洼田饮水试验评分)由干预前的(3.42 ± 0.85)分降至放疗结束当天的(1.67 ± 0.62)分，差异有统计学意义(P < 0.05)；患者血清白蛋白(ALB)、血红蛋白(Hb)水平较干预前显著升高，差异有统计学意义(P < 0.05)；干预期间，患者吸入性肺炎、营养不良、脱水等并发症发生率为8.75%，显著低于干预前回顾性统计的32.50%，差异有统计学意义(P < 0.05)。结论：对头颈肿瘤放疗患者实施科学、系统的吞咽功能护理评估，结合个性化康复训练指导，可有效改善患者吞咽功能，减轻吞咽困难症状，改善患者营养状况，降低相关并发症发生率，提高患者生活质量，值得临床推广应用。

Abstract: Objective: To retrospectively analyze the nursing assessment methods and the clinical effects of rehabilitation training guidance for swallowing dysfunction in patients undergoing radiotherapy for head and neck tumors, providing reference for clinical nursing practice. Methods: A retrospective analysis was conducted on 80 patients with swallowing dysfunction following radiotherapy for head and neck tumors, admitted to our hospital from January 2022 to December 2023. All patients received systematic nursing assessment of swallowing function (including clinical observation, standardized scale assessment, and auxiliary examination evaluation) and personalized rehabilitation training guidance (including basic training, oral muscle training, swallowing technique training, and dietary guidance). The intervention period lasted from the start of radiotherapy until three months after completion. Changes in swallowing function grading, dysphagia scores, nutritional indicators, and the incidence of complications were retrospectively analyzed before and after the intervention. Results: After the intervention, patients showed significant improvement in swallowing function grading compared to before the intervention. The proportion of patients with severe swallowing dysfunction decreased from 37.50% before the intervention to 8.75%, while the proportion of patients with mild swallowing dysfunction increased from 22.50% to 65.00%, with statistically significant differences (P < 0.05). The dysphagia score (Water Swallowing Test score) decreased from (3.42 ± 0.85) before the intervention to (1.67 ± 0.62) after the intervention, with a statistically significant difference (P < 0.05). Serum albumin (ALB) and hemoglobin (Hb) levels were significantly higher after the intervention compared to before (P < 0.05). The incidence of complications during the intervention, such as aspiration pneumonia, malnutrition, and dehydration, was 8.75%, significantly lower than the retrospective statistic of 32.50% before the intervention (P < 0.05). Conclusion: Implementing scientific and systematic nursing assessment of swallowing function, combined with personalized rehabilitation training guidance, can effectively improve swallowing function, alleviate dysphagia symptoms, enhance nutritional status, reduce the incidence of related complications, and improve the quality of life in patients undergoing radiotherapy for head and neck tumors. It is worthy of clinical promotion and application.