摘要目的? 探讨吞咽功能评估量表(Gugging Swallowing Screen,GUSS)在喉功能保全术后患者吞咽康复中的应用.方法? 采用便利抽样法,选取2016年2月—2018年2月在宁波市2家三甲医院行喉功能保全术的110例首诊喉癌患者为研究对象.采用完全随机法分为对照组(50例)和干预组(49例).对照组患者给予常规护理,依赖残喉自身的括约肌功能逐渐代偿恢复吞咽功能,进食流质无明显呛咳后拔除鼻饲管.干预组患者试进食开始使用GUSS量表引导吞咽康复训练,GUSS评分≥17分即拔除鼻饲管.比较两组患者的吞咽功能、鼻饲管留置时间、鼻饲管复插率、吸入性肺炎发生率及患者对康复的信心.结果? 术后第3、4周干预组吞咽功能恢复优于对照组(P＜0.05).干预组术后第2、3、4周的自我效能感评分优于对照组(P＜0.05).干预组的鼻饲管留置时间短于对照组(P＜0.05);两组的鼻饲管复插率比较差异无统计学意义(P＞0.05).干预组的吸入性肺炎发生率低于对照组(P＜0.05).结论? 对行喉功能保全术后患者使用GUSS量表引导吞咽训练,可以有效促进吞咽功能恢复,缩短鼻饲管留置时间,降低吸入性肺炎发生率,提高患者康复信心.

abstractsObjective? To explore the application of Gugging Swallowing Screen(GUSS) in swallowing rehabilitation of patients after laryngeal function preservation operation. Methods? Using convenience sampling method, 110 patients with first diagnosed laryngeal cancer who underwent laryngeal function preservation operation from February 2016 to February 2018 in two Class Ⅲ Grade A hospitals in Ningbo were selected as subjects. By complete random method, the patients were divided into control group (n=50) and intervention group (n=49). Patients in the control group were given routine nursing care, relying on the sphincter function of the residual larynx to gradually compensate for the recovery of swallowing function, and the nasogastric tube was removed after eating fluids without obvious cough. The intervention group used GUSS scale to guide swallowing rehabilitation training once they started eating. The nasogastric feeding tube was removed when GUSS score equaled or exceeded 17. The swallowing function, indwelling time of nasogastric tube, re-intubation rate of nasogastric tube, incidence of aspiration pneumonia and patients' confidence in recovery were compared between the two groups. Results? The recovery of swallowing function in the intervention group was better than that in the control group at 3 and 4 weeks after operation (P＜0.05). The self-efficacy score of intervention group was better than that of control group at 2, 3 and 4 weeks after operation (P＜0.05). The indwelling time of nasogastric tube in the intervention group was shorter than that in the control group (P＜ 0.05), and there was no statistical difference in the re-intubation rate of nasogastric tube between the two groups (P＞ 0.05). The incidence of aspiration pneumonia in intervention group was lower than that in control group (P＜ 0.05). Conclusions? Using GUSS scale to guide swallowing training for patients after laryngeal function preservation operation can effectively promote the recovery of swallowing function, shorten the indwelling time of nasogastric feeding tube, reduce the incidence of aspiration pneumonia,and improve patients' confidence in recovery.