摘要
目的探讨表面麻醉对球囊主动扩张治疗鼻咽癌放疗后吞咽障碍疗效的影响。方法选取54例鼻咽癌放射治疗后出现吞咽障碍的患者，采用随机数字表法将其分为表面麻醉组（表麻组）和无麻醉组（无麻组），表麻组患者进行球囊主动扩张前给予表面麻醉，无麻组患者进行球囊主动扩张前不给予表面麻醉；2组患者均同时辅以低频电刺激，持续治疗3周。于治疗前、后进行x线吞咽造影及吞咽自觉费力程度评定。结果治疗后2组患者咽启动延迟时间明显缩短、环咽肌开放程度明显增加（P〈0．05），喉部前移和上抬幅度亦显著改善（P〈0．05），自觉费力吞咽评分和无效吞咽次数均明显减少（P〈0．05），并且无麻组上述指标改善情况均显著优于表麻组（P〈0．05）；另外治疗后无麻组患者误吸率（3．6％）较治疗前（57．1％）及对照组水平（38．5％）均显著降低（P〈0．05），经口进食改善率（89．3％）较表麻组（61．5％）明显提高（P〈0．05）。结论球囊主动扩张配合低频电刺激治疗鼻咽癌放疗后吞咽障碍具有协同作用，有利于提高患者吞咽功能，且治疗时不采用表面麻醉的疗效优于使用表面麻醉。
Objective To investigate the effects of surface anesthesia on assisted balloon dilatation when treating dysphagia caused by radiotherapy for nasopharyngeal carcinoma. Methods Fifty-four patients with dyspha- gia after radiotherapy were divided randomly into an anesthesia group and a non-anesthesia group. The anesthesia group received anesthetics before treatment while the non-anesthesia group did not. All of the patients were treated with low-frequency electrical stimulation and assisted balloon dilatation for 3 weeks. They were then assessed using videofluoroscopy and self-reports of difficulty in swallowing before and after the treatment. Results After the treat- ment, significant improvement was observed in pharyngeal delay time, in cricopharyngeal opening, and in laryngeal elevation and forwardness. There was also a significant decrease in self-reported swallowing difficulty and failed swal- lows in both groups compared with before the treatment. The improvements in the non-anesthesia group were signifi- cantly greater than in the anesthesia group. After the treatment, the average aspiration rate of the anesthesia group was significantly higher than before treatment and higher than that of the non-anesthesia group. The improvement in o- ral intake of the non-anesthesia group was significantly better than that of the anesthesia group. Conclusion Bal- loon dilatation and low-frequency electrical stimulation have a synergistic effect and can improve patients＇ swallowing after radiation-induced cranial nerve damage, thus promoting survival. Assisted balloon dilatation without anesthesia has a better effect than when surface anesthesia is used.
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2015年第12期921-925,共5页
Chinese Journal of Physical Medicine and Rehabilitation
关键词
鼻咽癌
良性狭窄
吞咽障碍
表面麻醉
球囊扩张
Nasopharyngeal carcinoma
Benign stricture
Dysphagia
Surface anesthesia
Balloon dilatation
