上海交通大学学报(医学版) ›› 2023, Vol. 43 ›› Issue (10): 1289-1296.doi: 10.3969/j.issn.1674-8115.2023.10.010
• 论著 · 循证医学 • 上一篇
顾芬1(), 王悦平1(), 杨文玉1, 赵小妹1, 唐燕1, 沈淑坤1, 毛艳1, 张金凤1, 吴奕帆1, 张媛媛2, 杨悦3, 张剑春4, 余红5, 王兰6, 郝桂华1, 侯黎莉1()
收稿日期:
2023-03-26
接受日期:
2023-09-12
出版日期:
2023-10-28
发布日期:
2023-10-28
通讯作者:
侯黎莉
E-mail:gufen927@163.com;pisces_liz@163.com
作者简介:
顾 芬(1982—),女,主任护师,博士;电子信箱:gufen927@163.com基金资助:
GU Fen1(), WANG Yueping1(), YANG Wenyu1, ZHAO Xiaomei1, TANG Yan1, SHEN Shukun1, MAO Yan1, ZHANG Jinfeng1, WU Yifan1, ZHANG Yuanyuan2, YANG Yue3, ZHANG Jianchun4, YU Hong5, WANG Lan6, HAO Guihua1, HOU Lili1()
Received:
2023-03-26
Accepted:
2023-09-12
Online:
2023-10-28
Published:
2023-10-28
Contact:
HOU Lili
E-mail:gufen927@163.com;pisces_liz@163.com
Supported by:
摘要:
口腔颌面头颈肿瘤患者的肿瘤部位及大小、治疗方式以及预后情况会对其口腔功能及颈部活动产生重要影响,进而影响进食、言语、上肢运动等日常活动。口腔颌面头颈肿瘤术后早期康复可以加快功能恢复、缓解不适症状、提升生活质量、减少不必要的康复或治疗措施。制定口腔颌面头颈肿瘤临床康复护理路径,形成个体化康复方案,及早有效地开展护理干预,是当今口腔颌面头颈肿瘤临床工作的重点之一。目前国内外指南或共识较少关注言语功能、咀嚼吞咽功能、颈肩功能等方面的障碍,缺乏系统全面的康复护理指南或共识为口腔颌面头颈肿瘤护理提供实践指导。上海交通大学医学院附属第九人民医院组织北京、上海、四川、陕西、浙江、安徽的多位专家,参考以往相关文献,并结合临床护理一线的技术与经验,共同撰写《口腔颌面头颈肿瘤术后康复护理专家共识》,以期对口腔颌面头颈肿瘤患者在口腔护理、营养支持、皮瓣供区护理、气管切开护理、咀嚼吞咽康复、言语功能康复、颈肩功能康复、张口受限康复、风险识别与防范、随访方面提供技术指导。
中图分类号:
顾芬, 王悦平, 杨文玉, 赵小妹, 唐燕, 沈淑坤, 毛艳, 张金凤, 吴奕帆, 张媛媛, 杨悦, 张剑春, 余红, 王兰, 郝桂华, 侯黎莉. 口腔颌面头颈肿瘤术后康复护理专家共识[J]. 上海交通大学学报(医学版), 2023, 43(10): 1289-1296.
GU Fen, WANG Yueping, YANG Wenyu, ZHAO Xiaomei, TANG Yan, SHEN Shukun, MAO Yan, ZHANG Jinfeng, WU Yifan, ZHANG Yuanyuan, YANG Yue, ZHANG Jianchun, YU Hong, WANG Lan, HAO Guihua, HOU Lili. Expert consensus on postoperative rehabilitation nursing of patients with head and neck cancer[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(10): 1289-1296.
1 | DODD M J, MIASKOWSKI C, PAUL S M. Symptom clusters and their effect on the functional status of patients with cancer[J]. Oncol Nurs Forum, 2001, 28(3): 465-470. |
2 | COHEN E E, LAMONTE S J, ERB N L, et al. American Cancer Society Head and Neck Cancer Survivorship Care Guideline[J]. CA Cancer J Clin, 2016, 66(3): 203-239. |
3 | LIN M C, SHUENG P W, CHANG W K, et al. Consensus and clinical recommendations for nutritional intervention for head and neck cancer patients undergoing chemoradiotherapy in Taiwan[J]. Oral Oncol, 2018, 81: 16-21. |
4 | 中国抗癌协会肿瘤营养与支持专业委员会肿瘤放疗营养学组. 头颈部肿瘤放疗者营养与支持治疗专家共识[J]. 中华放射肿瘤学杂志, 2018, 27(1): 1-6. |
Cancer Radiotherapy Nutrition Group, Cancer Nutrition and Support Committee of China, China Anti-cancer Association. Expert consensus on nutrition support therapy for head and neck cancer patients receiving radiotherapy[J]. Chinese Journal of Radiation Oncology, 2018, 27(1): 1-6. | |
5 | 王延莉, 胡雁, 谢忠飞, 等. 头颈癌放疗患者营养管理的最佳证据总结[J]. 解放军护理杂志, 2022, 39(1): 63-67. |
WANG Y L, HU Y, XIE Z F, et al. Nutrition management in patients with head and neck cancer undergoing radiotherapy: a best evidence summary[J]. Nursing Journal of Chinese People's Liberation Army, 2022, 39(1): 63-67. | |
6 | 雷倍美, 李珍, 谢常宁, 等. 头颈部肿瘤患者吞咽功能促进策略的证据总结[J]. 中华护理杂志, 2023, 58(1): 85-91. |
LEI B M, LI Z, XIE C N, et al. Evidence summary for strategies to promote swallowing function in patients with head and neck tumors[J]. Chinese Journal of Nursing, 2023, 58(1): 85-91. | |
7 | CAUDELL J J, GILLISON M L, MAGHAMI E, et al. NCCN Guidelines® insights: head and neck cancers, version 1.2022[J]. J Natl Compr Cancer Netw, 2022, 20(3): 224-234. |
8 | WEIMANN A, BRAGA M, CARLI F, et al. ESPEN practical guideline: clinical nutrition in surgery[J]. Clin Nutr, 2021, 40(7): 4745-4761. |
9 | TROUILLET J L, COLLANGE O, BELAFIA F, et al. Tracheotomy in the intensive care unit: guidelines from a French expert panel[J]. Ann Intensive Care, 2018, 8(1): 37. |
10 | CHEE S Z, BYRNES Y M, CHORATH K T, et al. Interventions for trismus in head and neck cancer patients: a systematic review of randomized controlled trials[J]. Integr Cancer Ther, 2021, 20: 15347354211006474. |
11 | 刘英, 肖涛, 张小红, 等. 国内气管切开术后非机械通气患者气道湿化方法的网状Meta分析[J]. 中国实用护理杂志, 2019, 35(29): 2304-2309. |
LIU Y, XIAO T, ZHANG X H, et al. Network meta-analysis of airway humidification in patients with non-mechanical ventilation after domestic gastrectomy[J]. Chinese Journal of Practical Nursing, 2019, 35(29): 2304-2309. | |
12 | CHARTERS E, DUNN M, CHENG K, et al. Trismus therapy devices: a systematic review[J]. Oral Oncol, 2022, 126: 105728. |
13 | ZATARAIN L A, SMITH D K, DENG J, et al. A randomized feasibility trial to evaluate use of the jaw dynasplint to prevent trismus in patients with head and neck cancer receiving primary or adjuvant radiation-based therapy[J]. Integr Cancer Ther, 2018, 17(3): 960-967. |
14 | SATO Y, MINAGI S, AKAGAWA Y, et al. An evaluation of chewing function of complete denture wearers[J]. J Prosthet Dent, 1989, 62(1): 50-53. |
15 | 刘佩, 吴荷玉, 廖丽华. 改良经口气管插管固定方法在头面部手术中的应用[J]. 护理学杂志, 2018, 33(22): 44-45. |
LIU P, WU H Y, LIAO L H. Application of improved securement of oral endotracheal tube in head and facial surgery[J]. Journal of Nursing Science,2018, 33(22): 44-45. | |
16 | TUOMI L, JOHANSSON M, LINDELL E, et al. Voice range profile and health-related quality of life measurements following voice rehabilitation after radiotherapy; a randomized controlled study[J]. J Voice, 2017, 31(1): 115.e9-115.e16. |
17 | 马文娟, 唐晓燕, 王雅宁, 等. 手法推拿按摩在颈淋巴结清扫术后颈肩臂功能康复中的应用及效果评价[J]. 中医临床研究, 2020, 12(24): 85-87. |
MA W J, TANG X Y, WANG Y N, et al. Application and effect evaluation of manipulation massage in functional rehabilitation of neck, shoulder and arm after cervical lymph node dissection[J]. Clinical Journal of Chinese Medicine, 2020, 12(24): 85-87. | |
18 | DEGANELLO A, BATTAT N, MURATORI E, et al. Acupuncture in shoulder pain and functional impairment after neck dissection: a prospective randomized pilot study[J]. Laryngoscope, 2016, 126(8): 1790-1795. |
19 | SANDMAEL J A, BYE A, SOLHEIM T S, et al. Feasibility and preliminary effects of resistance training and nutritional supplements during versus after radiotherapy in patients with head and neck cancer: a pilot randomized trial[J]. Cancer, 2017, 123(22): 4440-4448. |
20 | LONKVIST C K, LØNBRO S, VINTHER A, et al. Progressive resistance training in head and neck cancer patients during concomitant chemoradiotherapy: design of the DAHANCA 31 randomized trial[J]. BMC Cancer, 2017, 17(1): 400. |
21 | LEE R A, MOLASSIOTIS A, ROGERS S N, et al. Protocol for the trismus trial—therabite versus wooden spatula in the amelioration of trismus in patients with head and neck cancer: randomised pilot study[J]. BMJ Open, 2018, 8(3): e021938. |
22 | 林晓, 赵丽芬, 曾明珠. 气道管理对高压氧治疗重度颅脑损伤患者疗效的影响[J]. 现代医药卫生, 2021, 37(13): 2263-2265. |
LIN X, ZHAO L F, ZENG M Z. Effect of airway management on hyperbaric oxygen therapy in patients with severe craniocerebral injury[J]. Journal of Modern Medicine & Health, 2021, 37(13): 2263-2265. | |
23 | 王国民, 朱川, 袁文化, 等. 汉语语音清晰度测试字表的建立和临床应用研究[J]. 上海口腔医学, 1995, 4(3): 125-127. |
WANG G M, ZHU C, YUAN W H, et al. Research on the establishment and clinical application of Chinese speech articulation test word table[J]. Shanghai Journal of Stomatology, 1995, 4(3): 125-127. | |
24 | 刘希, 魏曦. 肩颈康复操对颈淋巴结清扫术后患者肩颈功能恢复的研究[J]. 临床医药文献杂志(电子版), 2018, 5(25): 116-117. |
LIU X, WEI X. The study of shoulder and neck rehabilitation exercise on shoulder and neck function recovery of patients after neck lymph node dissection[J]. Journal of Clinical Medical Literature (Electronic Edition), 2018, 5(25): 116-117. | |
25 | 吴沛霞, 陈君仪, 周苹, 等. 喉癌颈淋巴清扫术后患者早期肩功能状况及其对生存质量的影响[J]. 护理学杂志, 2016, 31(14): 40-42. |
WU P X, CHEN J Y, ZHOU P, et al. Immediate postoperative shoulder function and its impact on quality of life in laryngectomized patients undergoing cervical lymph node dissection[J]. Journal of Nursing Science, 2016, 31(14): 40-42. | |
26 | MORIMOTO M, BIJL H P, VAN DER SCHAAF A, et al. Development of normal tissue complication probability model for trismus in head and neck cancer patients treated with radiotherapy: the role of dosimetric and clinical factors[J]. Anticancer Res, 2019, 39(12): 6787-6798. |
27 | LEE Y C, WONG T Y, SHIEH S J, et al. Trismus release in oral cancer patients[J]. Ann Plast Surg, 2012, 69(6): 598-601. |
28 | DE GROOT R J, MERKX M A W, HAMANN M N S, et al. Tongue function and its influence on masticatory performance in patients treated for oral cancer: a five-year prospective study[J]. Support Care Cancer, 2020, 28(3): 1491-1501. |
29 | 张慧敏, 刘俊杰, 刘进, 等. 口腔癌患者营养风险管理的循证实践[J]. 护理学杂志, 2022, 37(12): 88-91. |
ZHANG H M, LIU J J, LIU J, et al. Evidence-based practice of nutritional risk management in patients with oral cancer[J]. Journal of Nursing Science, 2022, 37(12): 88-91. | |
30 | DIJKSTRA P U, HUISMAN P M, ROODENBURG J N. Criteria for trismus in head and neck oncology[J]. Int J Oral Maxillofac Surg, 2006, 35(4): 337-342. |
31 | VAN DER GEER S J, VAN RIJN P V, KAMSTRA J I, et al. Criterion for trismus in head and neck cancer patients: a verification study[J]. Support Care Cancer, 2019, 27(3): 1129-1137. |
32 | RINKEL R N, VERDONCK-DE LEEUW I M, VAN REIJ E J, et al. Speech Handicap Index in patients with oral and pharyngeal cancer: better understanding of patients' complaints[J]. Head Neck, 2008, 30(7): 868-874. |
33 | 黄墁珊, 寻春雷. T-scan系统结合数字化模型测量咬合力分布的可靠性和准确性研究[J]. 中华口腔正畸学杂志, 2020, 27(2): 90-95. |
HUANG M S, XUN C L. Repeatability and validity of a modified method of measuring the occlusal force distribution with the T-scan system and digital models[J]. Chinese Journal of Orthodontics, 2020, 27(2): 90-95. | |
34 | 张淑彩, 赵超美, 徐静, 等. 游离皮瓣移植修复头颈部恶性肿瘤术后缺损的围术期护理[J]. 解放军护理杂志, 2008, 25(14): 43-44. |
ZHANG S C, ZHAO C M, XU J, et al. Perioperative nursing care of free skin flap transplantation for repairing defect after head and neck malignancy[J]. Nursing Journal of Chinese People's Liberation Army, 2008, 25(14): 43-44. | |
35 | 宫玉翠, 陈洁雅, 李平东, 等. 慢性呼吸疾病肺康复护理专家共识[J]. 中华护理杂志, 2020, 55(5): 709-710. |
GONG Y C, CHEN J Y, LI P D, et al. Expert consensus on pulmonary rehabilitation nursing of chronic respiratory diseases[J]. Chinese Journal of Nursing, 2020, 55(5): 709-710. | |
36 | 王成硕, 程雷, 刘争, 等. 耳鼻咽喉头颈外科围术期气道管理专家共识[J]. 中国耳鼻咽喉头颈外科, 2019, 26(9): 463-471. |
WANG C S, CHENG L, LIU Z, et al. Expert consensus on perioperative airway management in otolaryngology, head and neck surgery[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2019, 26(9): 463-471. | |
37 | 北京健康促进会呼吸及肿瘤介入诊疗联盟. 恶性中心气道狭窄经支气管镜介入诊疗专家共识[J]. 中华肺部疾病杂志(电子版), 2017, 10(6): 647-654. |
Respiratory and Tumor Interventional Diagnosis and Treatment Alliance, Beijing Health Promotion Association. Expert consensus on the diagnosis and treatment of malignant central airway stenosis through bronchoscopic intervention[J]. Chinese Journal of Lung Disease (Electronic Edition), 2017, 10(6): 647-654. | |
38 | GOYAL N, DAY A, EPSTEIN J, et al. Head and neck cancer survivorship consensus statement from the American Head and Neck Society[J]. Laryngoscope Investig Otolaryngol, 2022, 7(1): 70-92. |
39 | 中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗专业委员会. 中国头颈部肿瘤放射治疗指南(2021年版)[J]. 国际肿瘤学杂志, 2022, 49(2): 65-72. |
Chinese Society of Radiotherapy, Chinese Medical Doctor Association, Chinese Society of Radiotherapy, Chinese Medical Association, Chinese Society of Radiotherapy, China Anti-Cancer Association. Chinese Guidelines for Radiotherapy of Head and Neck Tumors (2021 edition)[J]. Journal of International Oncology, 2022, 49(2): 65-72. | |
40 | 中华护理学会. 成人经口气管插管机械通气患者口腔护理[S/OL]. (2021-02-01)[2023-08-20]. http://hltb.kxj.org.cn/uploads/admin/202301/63c76bb2b3f91.pdf. |
Chinese Nursing Association. Oral care for adult mechanically ventilated patients with orotracheal intubation[S/OL]. (2021-02-01)[2023-08-20]. http://hltb.kxj.org.cn/uploads/admin/202301/63c76bb 2b3f91.pdf. | |
41 | 中华护理学会. 成人肠内营养支持的护理[S/OL]. (2021-02-01)[2023-08-20]. http://hltb.kxj.org.cn/uploads/admin/202301/63c7822f 25851.pdf. |
Chinese Nursing Association. Nursing care of adult patients with enteral nutrition support[S/OL]. (2021-02-01)[2023-08-20]. http://hltb.kxj.org.cn/uploads/admin/202301/63c7822f25851.pdf. | |
42 | 中华护理学会. 气管切开非机械通气患者气道护理[S/OL]. (2019-11-10)[2023-08-20]. http://hltb.kxj.org.cn/uploads/admin/202301/63c 75b2dee28b.pdf. |
Chinese Nursing Association. Airway care for non-mechanically ventilated patients with tracheotomy[S/OL]. (2019-11-10)[2023-08-20]. http://hltb.kxj.org.cn/uploads/admin/202301/63c75b2dee28b.pdf. | |
43 | 崔朝妹, 刘静, 庄欣, 等. ICU成人患者有创机械通气撤机的最佳证据总结[J]. 护理学报, 2021, 28(6): 27-32 |
CUI Z M, LIU J, ZHUANG X, et al. Best evidence summary for weaning from mechanical ventilation of adult patients in intensive care unit[J]. Journal of Nursing, 2021, 28(6): 27-32. | |
44 | 李翔, 冯英璞, 孟晓静, 等. 脑卒中患者口腔健康管理的最佳证据总结[J]. 护理学报, 2022, 29(9): 36-41. |
LI X, FENG Y P, MENG X J, et al. Best evidence summary of oral health management for stroke patients[J]. Journal of Nursing, 2022, 29(9): 36-41. | |
45 | 严玉娇, 丁娟, 刘晁含, 等. 成人危重症患者气道管理的最佳证据总结[J]. 护理学报, 2021, 28(3): 39-45. |
YAN Y J, DING J, LIU C H, et al. Best evidence summary for airway management in critically-ill adult patients[J]. Journal of Nursing, 2021, 28(3): 39-45. | |
46 | 刘洪娟, 张春瑾, 王玮荻, 等. 颈部手术后气道梗阻预防及管理的最佳证据总结[J]. 护士进修杂志, 2021, 36(10): 948-953. |
LIU H J, ZHANG C J, WANG W D, et al. Summary of the best evidence for the prevention and management of airway obstruction after neck surgery[J]. Journal of Nurses Training, 2021, 36(10): 948-953. | |
47 | 黄瑶, 俞蕾蕾, 杨悦来, 等. 头颈部肿瘤患者症状群评估工具的研究进展[J]. 中国口腔颌面外科杂志, 2019, 17(5): 473-477. |
HUANG Y, YU L L, YANG Y L, et al. Studies on symptom cluster assessment tools for patients with head and neck cancers[J]. China Journal of Oral and Maxillofacial Surgery, 2019, 17(5): 473-477. | |
48 | RAPIDIS A D, DIJKSTRA P U, ROODENBURG J N, et al. Trismus in patients with head and neck cancer: etiopathogenesis, diagnosis and management[J]. Clin Otolaryngol, 2015, 40(6): 516-526. |
49 | 吴昊, 周子疌, 张成瑶, 等. 头颈部恶性肿瘤患者治疗后张口困难的研究进展[J]. 口腔疾病防治, 2021, 29(7): 490-495. |
WU H, ZHOU Z J, ZHANG C Y, et al. Research progress on posttreatment trismus in malignant head and neck tumors[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2021, 29(7): 490-495. | |
50 | BRADLEY P J, FERLITO A, SILVER C E, et al. Neck treatment and shoulder morbidity: still a challenge[J]. Head Neck, 2011, 33(7): 1060-1067. |
51 | 黄志强, 程永波. 口腔微生态环境及口腔微生态源性口臭的治疗研究进展[J]. 山东医药, 2021, 61(35): 112-115. |
HUANG Z Q, CHENG Y B. Research progress of oral microecological environment and treatment of oral microecological halitosis[J]. Shandong Medical Journal, 2021, 61(35): 112-115. | |
52 | 石汉平. 肿瘤营养疗法[J]. 中国临床营养, 2014, 41(18): 1141-1144. |
SHI H P. Cancer nutrition therapy[J]. Chinese Journal of Clinical Nutrition, 2014, 41(18): 1141-1144. | |
53 | 李春洁, 毕小琴, 朱桂全. 口腔颌面部肿瘤患者游离皮瓣修复术的并发症预防及处理[J]. 国际口腔医学杂志, 2023, 50(2): 127-137. |
LI C J, BI X Q, ZHU G Q. Complications prevention and treatment after free flap reconstructive surgery for oral and maxillofacial tumor patients[J]. International Journal of Stomatology, 2023, 50(2): 127-137. | |
54 | 李思敏, 吴姁怿, 王娇, 等. 气管切开患者拔管管理研究进展[J]. 华西医学, 2022, 37(5): 783-787. |
LI S M, WU X Y, WANG J, et al. Research progress of extubation management in patients with tracheotomy[J]. West China Medical Journal, 2022, 37(5): 783-787. | |
55 | 彭飞. 呼吸机相关性肺炎防控最佳护理实践: «导管相关感染防控最佳护理实践专家共识»系列解读之三[J]. 上海护理, 2020, 20(6): 1-4. |
PENG F. Best nursing practice for prevention and control of ventilator-associated pneumonia interpretation (Ⅲ) of Expert Consensus on Best Nursing Practice for Prevention and Control of Catheter-related Infection[J]. Shanghai Nursing Journal, 2020, 20(6): 1-4. | |
56 | 韦伟, 李朋. 甲状腺癌颈淋巴结清扫术常见并发症及其防治[J]. 中国实用外科杂志, 2017, 37(9): 970-973. |
WEI W, LI P. Major complications and prevention of cervical lymph node dissection for thyroid carcinoma[J]. Chinese Journal of Practical Surgery, 2017, 37(9): 970-973. | |
57 | 温瑞芳, 梁冠冕, 江子芳. 颈淋巴结清扫术后肩功能评估及康复锻炼研究进展[J]. 护理研究, 2021, 35(16): 2910-2915. |
WEN R F, LIANG G M, JIANG Z F. Research progress on shoulder function evaluation and rehabilitation exercise after neck dissection[J]. Chinese Nursing Research, 2021, 35(16): 2910-2915. | |
58 | 龚湖萍, 魏清风, 安冬. 头颈癌术后患者自我形象研究进展[J]. 中国护理管理, 2018, 18(4): 542-545. |
GONG H P, WEI Q F, AN D. The body image and its influence factors of postoperative patients with head and neck cancer: a review[J]. Chinese Nursing Management, 2018, 18(4): 542-545. | |
59 | NAHUM A M, MULLALLY W, MARMOR L. A syndrome resulting from radical neck dissection[J]. Arch Otolaryngol, 1961, 74: 424-428. |
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[2] | 许洋 1, 2,刘凯雄 1, 2,瞿介明 1, 2. 基于 2017版《变应性支气管肺曲霉病诊治专家共识》的病例分析[J]. 上海交通大学学报(医学版), 2018, 38(10): 1191-. |
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