头颈部恶性肿瘤患者放疗后吞咽困难的危险因素分析及吞咽功能训练的临床应用价值

摘要 目的：分析头颈部恶性肿瘤（HNC）患者放疗后吞咽困难的危险因素，并观察吞咽功能训练的临床应用效果。方法：选择2020年4月~2022年5月期间在华中科技大学同济医学院附属同济医院接受放疗的HNC患者150例。采用自制调查量表获取患者的一般资料，采用单因素和多因素Logistic分析HNC患者放疗后吞咽困难的危险因素，并观察吞咽功能训练的临床应用效果。结果：本研究中150例HNC患者，放疗后出现吞咽困难的有93例，吞咽困难发生率为62.00%。根据放疗后是否出现吞咽困难将患者分为无吞咽困难组（n=57）和吞咽困难组（n=93）。单因素分析显示，HNC患者放疗后吞咽困难与文化程度、婚姻状况、高血压、糖尿病、高脂血症、居住地、体质量指数无关（P>0.05），而与年龄、性别、吸烟史、饮酒史、肿瘤分期、肿瘤位置、累积放疗剂量有关（P<0.05）。多因素Logistic回归分析，结果显示：年龄偏大、男性、吸烟史、饮酒史、肿瘤分期为III期、肿瘤位置为颈部肿瘤、累积放疗剂量偏高是HNC患者放疗后吞咽困难的危险因素（P<0.05）。HNC患者干预1个月后、干预2个月后安德森吞咽困难量表（MDADI）评分较干预前下降，功能性经口摄食量表（FOIS）评分较干预前升高（P<0.05）。结论：HNC患者放疗后吞咽困难的发生率较高，年龄、性别、吸烟史、饮酒史、肿瘤分期、肿瘤位置、累积放疗剂量等均是其影响因素。HNC患者放疗期间给予吞咽功能训练，可有效改善患者的吞咽状况。

Analysis of Risk Factors of Dysphagia in Patients with Head and Neck Malignant Tumors after Radiotherapy and Clinical Application Value of Swallowing Function Training

ABSTRACT Objective: To analyze the risk factors of dysphagia in patients with head and neck cancer (HNC) after radiotherapy, and to observe the clinical application effect of swallowing function training. Methods: 150 patients with HNC who received radiotherapy in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2020 to May 2022 were selected. General data of patients were obtained by self-made survey scale.Univariate and multivariate Logistic analysis were used to analyze the risk factors of dysphagia in patients with HNC after radiotherapy, and the clinical application effect of swallowing function training was observed. Results: In this study, among 150 patients with HNC, 93 had dysphagia after radiotherapy, with an incidence of 62.00%. According to whether there was dysphagia after radiotherapy, the patients were divided into the non-dysphagia group (n=57) and the dysphagia group(n=93). Univariate analysis showed that the dysphagia of patients with HNC after radiotherapy was not related to education level, marital status, hypertension, diabetes, hyperlipidemia, residence and body mass index (P>0.05), but was related to age, gender, smoking history, drinking history, tumor stage, tumor location and cumulative radiotherapy dose(P<0.05). Multivariate Logistic regression analysis showed that older age, male, smoking history, drinking history, stage III tumor, tumor location with cervical tumor, and high cumulative radiotherapy dose were risk factors for dysphagia after radiotherapy in patients with HNC(P<0.05). The M.D.Anderson Dysphagia Inventory(MDADI) score of patients with HNC decreased 1 month after intervention and 2 months after intervention compared with before intervention, the score of Functional Oral Ingestion Score(FOIS) was higher than that before intervention (P<0.05). Conclusion: The incidence of dysphagia after radiotherapy is higher in patients with HNC, and age, gender, smoking history, drinking history, tumor stage, tumor location, and cumulative radiotherapy dose, etc. are all influencing factors. Swallowing function training during radiotherapy in patients with HNC can effectively improve swallowing status.