吞咽生命质量量表联合纤维内镜下吞咽功能检查技术在鼻咽癌放化疗后吞咽障碍患者中的应用

doi:10.6040/j.issn.1673-3770.0.2021.249

摘要/Abstract

摘要： 目的吞咽生命质量量表(SWAL-QOL)联合纤维内镜下吞咽功能检查技术(FEES)对鼻咽癌放化疗后吞咽障碍患者的吞咽功能进行评估,以了解经放化疗后的鼻咽癌患者的吞咽相关生活质量情况,并拓展二者在临床中的应用。方法纳入2019年9月至2020年3月在四川大学华西医院随访的经放化疗治疗的、且存在吞咽障碍的162例鼻咽癌患者为病例组,纳入健康人144例为对照组,两组均填写SWAL-QOL。并对病例组96例患者进行FEES检查,再根据渗漏/误吸量表(PAS)对其吞咽障碍严重程度进行分级。结果病例组SWAL-QOL中生活质量量表的总分(124.69±25.57)及吞咽症状维度得分(58.56±9.46)均明显低于对照组,且组间差异有统计学意义(P<0.05);生活质量量表中,除“疲劳”“睡眠”维度外,其余8个维度差异均具有统计学意义(P<0.05)。根据PAS评分显示,无渗漏组22例(22.92%),喉渗漏组60例(62.50%),隐性误吸组14例(14.58%),分组比较:3组病例对比发现,SWAL-QOL总分及“言语交流”“进食恐惧”“疲劳”“睡眠”各维度差异具有统计学意义(P<0.05)。对比无渗漏组与喉渗漏组SWAL-QOL总分、吞咽症状维度评分及生活质量量表各维度的差异均无统计学意义(P>0.05)。对比无渗漏组和隐性误吸组,SWAL-QOL总分、进食时间、言语交流、睡眠各维度的差异有统计学意义(P<0.05),但吞咽症状及其他维度差异无统计学意义(P>0.05)。对比喉渗漏组和隐性误吸组,SWAL-QOL总分,“言语交流”“睡眠”各维度差异有统计学意义(P<0.05),吞咽症状及其他维度差异无统计学意义(P>0.05)。结论吞咽障碍对鼻咽癌放化疗后患者生活质量影响是多方面的;SWAL-QOL可联合FEES技术,并结合PAS评分对经放化疗后的鼻咽癌患者的吞咽功能进行评估及吞咽障碍严重程度分级,且PAS分级越高,其SWAL-QOL的评分越低。

关键词: 鼻咽癌, 吞咽障碍, 吞咽生命质量量表, 纤维内镜下吞咽功能检查技术, 评估

Abstract: Objective to evaluate the post-chemoradiotherapy quality of life of nasopharyngeal carcinoma patients with dysphagia using the swallowing quality of life(SWAL-QOL)scale and fiberoptic endoscopic evaluation of swallowing(FEES)in order to expand the clinical applications. Methods A total of 162 nasopharyngeal carcinoma patients meeting the inclusion criteria were enrolled as the patient group in the West China Hospital from September 2019 to April 2020, who had received chemoradiotherapy and were with dysphagia problem. Additionally, 144 individuals without relevant problems were recruited as the control group. All the participants were asked to fill the SWAL-QOL scale, and 96 individuals from the patient group received further FEES examination and were graded by the Penetration-Aspiration Scale(PAS). Results Participants in patient group had significantly lower total scores(124.69±25.57)and swallowing symptoms subscale scores(58.56±9.46)than those in control group(P<0.05). In the quality of life subscale, except for the two dimensions of “fatigue” and “sleep”, the differences in other dimensions were statistically significant(P<0.05). Significant differences were presented in all other dimensions,except for “fatigue” and “sleep”. The PAS results revealed 22 patients with no penetration(22.92%), 60 patients with penetration(62.50%)and 14 patients with silent aspiration(14.58%). Significant difference was observed in the three goups, include the total scores of SWAL-QOL and the scores of 4 dimensions in the questionnaire. No significant difference was presented between groups of no penetration and penetration in the total scores of SWAL-QOL and the scores of all the dimensions in the questionnaire(P>0.05). However, significant difference was observed between groups of no penetration and silent aspiration in the total scores of SWAL-QOL and the scores of 4 dimensions in the questionnaire(P<0.05). Significant difference was observed between groups of penetration and silent aspiration in the total scores of SWAL-QOL and the scores of 2 dimensions in the questionnaire(P<0.05). Conclusion Dysphagia could affect the post- chemoradiotherapy quality of life of nasopharyngeal carcinoma patients in many aspects. Additionally, the SWAL-QOL can be used to evaluate the swallowing-related quality of life of nasopharyngeal carcinoma patients after chemoradiotherapy.

Key words: Nasopharyngeal carcinoma, Dysphagia, Swallowing quality of Life, Fiberoptic endoscopic eraluation of swallowing, Assessment

中图分类号:

R856.76

任佳,吕丹,张银,孙佳莉,马兰,郑义涛,杨济民, 于凌昱,李波. 吞咽生命质量量表联合纤维内镜下吞咽功能检查技术在鼻咽癌放化疗后吞咽障碍患者中的应用[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 83-88.

REN Jia, LÜ Dan, ZHANG Yin, SUN Jiali, MA Lan, ZHENG Yitao, YANG Jimin, YU Lingyu, LI Bo. Application of combining fiberoptic endoscopic evaluation of swallowing technology and swallowing quality of life scale in patients with dysphagia after chemoradiotherapy for nasopharyngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(6): 83-88.

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