Construction Of Early Swallowing Rehabilitation Training Program For Patients Based On The Concept Of Enhanced Recovery After Surgery

Objective:Systematic search and evaluation of early swallowing rehabilitation training after partial laryngectomy for patients with laryngeal cancer,summarize evidence-based evidence,build an early swallowing rehabilitation training program for patients with partial laryngeal resection based on the concept of accelerated rehabilitation surgery,and carry out clinical trial research,in order to lay a foundation for clinical popularization and application.Methods:This study mainly consists of three main parts:1.Summary of evidence of early swallowing rehabilitation training in patients with partial laryngeal resection for laryngeal cancer.To pose the evidence-based questions,Systematic search BMJ best clinical practice,Up To Date,GIN,NICE,NGC,NCCN,Medical pulse,The Cochrane Library,JBI evidence-based health care center,CINAHL,Pub Med,CNKI,CBM have all the evidence about laryngectomy swallowing training,Including guidelines,expert consensus,best practices,systematic reviews,evidence summary,and original studies,and searching the grey literature,the retrieval time limit is for the database construction until April 2021,After strict literature quality evaluation,evidence extraction and evidence grading,Conduct the best evidence summary.2.Construction of an early swallowing rehabilitation training program in patients with partial laryngeal resection of laryngeal cancer.Based on the summary of the best evidence and based on the concept of enhanced recovery after surgery(ERAS),after the research group discussion,the first draft of the early swallowing rehabilitation training program for patients with partial laryngeal resection of laryngeal cancer was formulated,an expert meeting was held to demonstrate the first draft,and the early swallowing rehabilitation training program for patients with partial laryngeal resection of laryngeal cancer was constructed.3.Trial study of early swallowing rehabilitation in patients based on ERAS concept.Using convenient sampling method,selected in July 2021-January 2022 Shanxi Province a tertiary class hospital otolaryngology head and neck surgery hospital for the first diagnosis of laryngeal cancer and partial laryngectomy patients as the research object,according to the time of admission order is divided into control group,intervention group,control group give regular swallowing training,intervention group on the basis of the early construction of early swallowing rehabilitation training program.The swallowing function was evaluated by the standard swallowing function scale(SSA)before and at 2 weeks and 3 weeks after surgery,the quality of life was assessed using the UW-QOL at 1 week and 4 weeks after surgery,and the time of gastric tube extraction,number of complications and hospital stay were recorded.Results:The three-part results of this study are presented as follows:1.According to the retrieval strategy,system search domestic and foreign databases,preliminary 3049 literature,after screening,into the standard of 18 literature,including 3guidelines,5 expert consensus,6 system evaluation,4 randomized controlled trial,evidence extraction and integration,finally in preventive rehabilitation exercise,evaluation,nutrition management,swallowing function exercise,compensatory strategy,oral hygiene,respiratory training,multidisciplinary management 8 aspects form 24 best evidence.2.According to the panel discussion and expert meeting method,finally formed based on the concept of ERAS partial laryngeal resection patients early swallowing rehabilitation training program,mainly includes six parts: preparation,evaluation,preventive swallowing training,swallowing function rehabilitation training,compensatory training and risk management.3.Clinical trial study of early swallowing rehabilitation training in patients with partial laryngectomy based on ERAS concept included a total of 28 patients who met the criteria for first laryngeal cancer and proposed partial laryngectomy,In the control group,among the 15 patients,In the intervention group,13 patients,The results showed that the baseline data of the two groups were comparable,There was no significant difference(P> 0.05);SSA scores in the 3 weeks postoperative intervention group(28.82±1.53 vs31.85±2.17,P <0.05)was lower than that in the control group;Time of gastric tube retention in the intervention group [15.00(3.00)vs 17.00(5.00),P <0.05] and length of stay(27.09±3.56 vs 30.33±4.13,P <0.05)was shorter than that in the control group;The ates of complications in the intervention and control groups(15.38% vs 6.67%,P>0.05)showed no statistically significant difference from the quality of life score(614.33±45.70 vs 637.31±53.60,P>0.05)at 4 weeks after surgery.Conclusion:The early swallowing rehabilitation training program for partial laryngeal resection patients constructed based on the concept of accelerated rehabilitation surgery is normative,systematic and practical,and can be better applied to laryngeal cancer patients undergoing partial laryngectomy,assisting them to establish a swallowing compensation mechanism as soon as possible and accelerate the recovery of postoperative swallowing function.