不同粘稠度食物对鼻咽癌放疗术后吞咽障碍患者吞咽生理成分及渗漏误吸的影响

关键词：鼻咽癌放疗后  吞咽障碍  吞咽  粘稠度  误吸

Keywords:nasopharyngeal carcinoma after radiotherapy  dysphagia  swallow  consistency  aspiration

摘要：

      摘要 目的：探讨鼻咽癌放疗术后吞咽障碍患者进食不同粘稠度食物与吞咽生理成分及渗漏误吸的相关性，为此类患者进食指导及康复治疗提供依据。 方法：选取67例鼻咽癌放疗术后出现吞咽障碍的患者进行吞咽造影检查，按中稠度-低稠度-原液-高稠度的顺序进食每口量5ml的食团，使用改良钡剂吞咽造影量表（modified Barium swallow impairment profile，MBSImP）及渗漏误吸分级量表（penetration-aspiration scale，PAS）进行半定量分析判定各生理成分分级。 结果：入选患者吞咽四种粘稠度食团时，口腔残留、咽期吞咽启动、喉上抬、喉前庭关闭、咽收缩、舌根收缩和咽部残留的生理表现最差概率范围差异较大；随着食团粘稠度降低，渗漏误吸发生率增加；其渗漏误吸分级与舌团运送（r=0.455，P＜0.01）、吞咽启动（r=0.519，P＜0.01）、舌根收缩（r=0.415，P＜0.01）呈中等程度相关，与会厌翻转（r=0.739，P＜0.01）和喉前庭关闭（r=0.885，P＜0.01）呈强相关。 结论：鼻咽癌放疗术后吞咽障碍患者各吞咽生理成分表现与食团粘稠度密切相关，且其渗漏误吸的发生不仅与会厌翻转和喉前庭关闭呈强相关，还与食团运送、吞咽启动、舌根收缩呈中等程度相关。

Abstract:

      Abstract Objective： To explore the correlation between bolus of different viscosity and swallowing physiological components，as well as penetration and aspiration， in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma. Method： Total 67 patients with dysphagia after NPCR were evaluated by videofluoroscop. They were required to swallow 5 ml bolus per mouth， in the order of medium-low-zero-high consistency. Modified barium swallow impairment profile（MBSImP）and penetration-aspiration scale（PAS） were used for semi-quantitative analysis. Result： Wide probability ranges （＞0.2） can be observed between different swallowing tasks for 7 physiological components： oral residue， initiation of pharyngeal swallow， laryngeal elevation， laryngeal vestibular closure， pharyngeal contraction， tongue base retraction， and pharyngeal residue. The risk of penetration and aspiration increased with lower viscosity. There was a significant positive correlation between the penetration aspiration scale and epiglottic movement，laryngeal vestibular closure， bolus transpor， initiation of pharyngeal swallow and tongue base retraction. Conclusion： The performance of swallowing physiological components in patients with dysphagia after NPCR are closely related to the viscosity of the bolus being swallowed.