| Objective:The purpose of this study was to investigate the effect of preventive swallowing intervention in patients with laryngeal cancer undergoing partial laryngectomy.To explore the effects of different preventive swallowing intervention programs on swallowing safety,swallowing function,oral feeding function,nutrition and quality of life of patients to provide scientific intervention strategies and a reference basis for dysphagia management after laryngeal cancer surgery.Method:From October 2020 to November 2021,75 laryngeal cancer patients were enrolled in a third-class hospital in Changchun city,and they were randomly divided into three groups.The control group received basic swallowing training.On this basis,intervention group 1 adopted the joint intervention program of jaw resistance and respiratory muscle coordination training,while intervention group 2 adopted the intervention program of respiratory muscle coordination training and carried out a onemonth preventive swallowing intervention program study.Before,during and after the intervention,the swallowing safety,swallowing function,oral feeding function,nutrition,quality of life and rehabilitation compliance of patients were evaluated.Among them,the safety of swallowing was evaluated by Fberoptic Endoscopic Evaluation of Swallowing（FEES）combined with the Penetration Aspiration Scale（PAS）and the Yale Pharyngeal Residue Severity Rating Scale（YPRS）.Swallowing function was assessed by the Water Swallow Test and the Eating Assessment Tool-10（EAT-10）.Oral feeding function was evaluated by the Functional Oral Intake Scale（FOIS）.The nutritional status was evaluated by Body mass index（BMI）,albumin,prealbumin and patient-generated subjective global assessment（PG-SGA）.Quality of life was assessed by the M.D.Anderson Dysphasia Inventory（MDADI）and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30（EORTC QLQ-C30）.Using SPSS 24.0 statistical software to analyse the research data,it is assumed that the test level α=0.05,and P<0.05 is considered to indicate a significant difference.Results:（1）Swallowing safety: Compared with the control group,the PAS and YPRS scores of swallowing different traits of food in intervention group 1 were significantly different under FEES 7 days,14 days and 1 month after the operation（P<0.05）.The PAS and YPRS scores of the intervention 2 groups were also significantly different from those of the control group 14 days and 1 month after the operation（P<0.05）.There was no significant difference in PAS or YPRS scores between the two groups in the intervention group（P>0.05）.（2）Swallowing function: In intervention group 1,the differences of Watian drinking water test and EAT-10 score were statistically significant compared with those in the control group 7 days,14 days and one month after operation（P<0.05）.In intervention group 2,the Watian drinking water test and EAT-10 score were better than those in the control group 14 days and one month after operation（P<0.05）.Moreover,the Watian drinking water test and EAT-10 score of intervention 1 group were significantly better than those of intervention 2 group 14 days and one month after operation（P<0.05）.（3）Oral feeding function: The FOIS scores of the intervention group 1 were significantly different from those of the control group 7 days,14 days and one month after operation（P<0.05）.The FOIS scores of the intervention groups 2 were significantly better than those of the control group 14 days and one month after operation（P<0.05）.Moreover,one month after surgery,the FOIS score of intervention group 1 was significantly different from that of intervention group 2（P<0.05）.（4）Nutritional status: Compared with the control group,the albumin index and PG-SGA score of the intervention group were significantly different on the 7th day,14 th day and one month after the operation（P<0.05）.The prealbumin index of the intervention group was also significantly different on the 14 th day and one month after the operation（P<0.05）.However,there was no significant difference in BMI among the groups at the three time points（P>0.05）.In addition,one month after surgery,the PGSGA score in intervention group 1 was significantly better than that in intervention group 2（P<0.05）.（5）Quality of life: 7 days after surgery,the scores of swallowing function,emotion,body function on the MDADI and the functional domain score on the EORTC QLQ-C30 in the intervention group were significantly different from those in the control group（P<0.05）.The intervention group outperformed the control group in all areas of MDADI,EORTC QLQ-C30 function and symptom scores 14 days and 1 month after surgery（P<0.05）.In addition,one month after surgery,the difference in MDADI swallowing function scores between intervention group 1 and intervention group 2 was statistically significant（P<0.05）.Conclusion:The preventive swallowing intervention plan can effectively improve or reduce the dysphagia of patients after partial laryngectomy for laryngeal cancer.Compared with the single measure,the combined intervention of preventive mandibular resistance and respiratory muscle coordination training can more effectively reduce swallowing safety problems such as aspiration and residue of food after surgery,improve swallowing function,promote the patients to recover from oral feeding,reduce the risk of malnutrition,and improve the quality of life of patients. |
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