陈芳芳 桂意华 励莉 周艳 黄琦 任建军 郑亚华

[摘要] 目的 探討不同黏稠度食物在环状软骨上喉部分切除术（SCPL）患者的早期吞咽适应情况。 方法 选取2018年6月至2019年12月某三甲医院行环状软骨上喉部分切除术的首诊喉癌患者25例为研究对象。根据国际吞咽障碍食物标准IDDSI配制软食型食物（IDDSI 6级）、细泥型食物（IDDSI 4级）、中稠型食物（IDDSI 2级）、稀薄型食物（IDDSI 0级）;患者均于术后15、20 d试食黏稠度等级递减的序位食物，采用顺序纤维内镜吞咽功能检查法（FEES）结合改良误侵误吸计分量表（MPAS）观察患者术后不同时段摄食不同黏稠度食物的吞咽情况。 结果 术后15、20 d的FEES+MPAS评分显示，患者对吞咽不同性状食物的适应程度不同（F=4.895，P=0.003）;术后20 d，患者对不同黏稠度食物吞咽适应情况不同，差异有统计学意义（F=6.581，P<0.001）;LSD法多重比较结果显示，15 d软食型食物与其余3种黏稠度食物两两之间的患者吞咽适应比较，差异有统计学意义（P<0.05），20 d软食型食物与细泥型食物之间比较，差异无统计学意义（P>0.05），但两者与中稠型食物、稀薄型食物之间比较，差异有统计学意义（P<0.05）。 结论 不同黏稠度食物对SCPL患者早期康复时段新喉结构适应度不一样，选择最佳黏稠度食物可降低误吸、误侵及肺部感染的风险，保障患者进食安全与营养，从而促进吞咽功能康复。

[关键词] 食物黏稠度;环状软骨上喉部分切除术;吞咽障碍;纤维内镜吞咽检查

[中图分类号] R743.3          [文献标识码] B          [文章编号] 1673-9701（2021）32-0177-04

[Abstract] Objective To investigate the early swallowing adaptation of foods with different viscosity in patients undergoing supracricoid partial laryngectomy （SCPL）. Methods A total of 25 patients with laryngeal cancer first diagnosed who underwent SCPL admitted to a tertiary hospital from June 2018 to December 2019 were selected as the research objects. According to the International Dysphagia Diet Standardization Initiative （IDDSI）， the soft food （IDDSI level 6）， fine mud food （IDDSI level 4）， medium thick food （IDDSI level 2） and thin food （IDDSI level 0） were prepared. Every subject tried to eat food with the sequence of decreasing viscosity grade on the 15th and 20th day after operation. The swallowing status of food with different viscosity at different time after operation by sequential fiberoptic endoscopic evaluation of swallowing （FEES） combined with modified penetration aspiration scale （MPAS）. Results The scores of FEES+ MPAS in SCPL patients on the 15th and 20th day after operation showed that patients have different adaptations to swallowing different shapes of food（P=0.003，F=4.895）;twenty days after surgery，patients have different adaptations to swallowing foods with different viscosity， and the difference is statistically significant（P<0.001，F=6.581）.The multiple comparison results of LSD showed that there were statistically significant differences between soft food and the other three kinds of viscosity of foods on the 15th day （P<0.05）， and there were no differences between soft food and fine mud food on the 20th day（P>0.05）， but there were statistically significant differences between them and the medium thick food and thin food （P<0.05）. Conclusion Different viscosity foods have different adaptability to the new laryngeal structure in early rehabilitation period of SCPL patients. Choosing the best viscosity food can reduce the risk of aspiration， penetration and pulmonary infection， ensure the safety and nutrition of patients， and promote the rehabilitation of swallowing function.

[Key words] Food viscosity; Supracricoid partial laryngectomy; Dysphagia; Fiberoptic endoscopic evaluation of swallowing

近年来，我国喉癌发病率呈上升且年轻化趋势[1]。喉部分切除术是治疗喉癌的常用术式，其中环状软骨上喉部分切除术（Supracricoid partial laryngectomy， SCPL）是喉部分切除术经典术式之一[2]。……