优质护理促进舌癌联合根治术后患者康复的临床研究

目的：探讨优质护理服务对舌癌联合根治术后患者康复的影响。方法：将86例舌癌患者按时间先后分为对照组26例，优护组60例。对照组给予常规护理，优护组按照责任制整体护理模式，根据患者病情制定针对性的康复护理计划、跟踪指导语音康复训练并进行评价、坚持做好出院随访。结果：优护组出院满意度评价及术后3个月语音清晰度评分均显著优于对照组（均P＜0．01）。结论：开展优质护理服务，对舌癌联合根治术后患者康复具有促进作用。     

舌癌患者术后1年生存质量的相关因素分析

目的：探讨舌癌患者术后1年的生存质量变化及其相关影响因素。方法：选择2003—2005年中山大学附属第二医院口腔颌面外科手术治疗的93例舌癌患者，在术前及术后1年时，由患者自主完成华盛顿大学生存质量问卷（第4版）填写，分析生存质量的变化；利用SPSS11．5软件包进行非参数检验和多因素线性回归分析。结果：术后12个月，生存质量问卷的总体生存质量接近术前；术后12个月时，生存质量问卷的外形、行为、语言和肩部功能分值较术前显著下降，差异有统计学意义（P〈0．05）；而疼痛、抑郁和焦虑分值较术前升高，差异有统计学意义（P〈0．05）。多因素回归分析显示，临床分期、放疗、年龄、社会经济因素影响生存质量。结论：早期发现、早期治疗舌癌，提高患者的社会经济水平。对提高生存质量有重要意义。     

重组人表皮生长因子外用溶液联合重组人粒细胞刺激因子治疗化疗所致口腔黏膜炎的效果

目的:探讨重组人表皮生长因子外用溶液联合重组人粒细胞刺激因子(recombinant human granulocyte stimulating factor, RHGSF)治疗化疗所致口腔黏膜炎的效果及对患者血管内皮生长因子的影响。方法:选取2019年12月～2020年12月我院收治的化疗所致口腔黏膜炎患者94例,随机分为对照组和研究组各47例,对照组应用重组人表皮生长因子外用溶液治疗,研究组应用重组人表皮生长因子外用溶液联合RHGSF治疗。观察分析两组患者的临床疗效、口腔pH值、VAS评分、血清HIF-1α、VEGF水平情况。结果:治疗后,研究组临床疗效(95.74%)明显高于对照组(76.60%),差异具有统计学意义(P<0.05);治疗前两组VAS评分差异无统计学意义(P>0.05),治疗后研究组VAS评分低于对照组,差异具有统计学意义(P<0.05);治疗前,两组口腔PH值差异无统计学意义(P>0.05),治疗后研究组口腔PH值低于对照组,差异具有统计学意义(P<0.05);治疗后,研究组血清HIF-1α的平均水平为(4.8±1.1) ng/L,...     

两种消毒法在舌癌术后患者口腔护理中应用的比较

目的 :比较口内冲洗消毒法与传统口腔护理在舌癌术后患者口腔护理中的临床效果。方法 :将舌癌术后的60例患者,按随机数字方法分为2组。对照组采用传统的1.5%双氧水和生理盐水棉球擦拭进行口腔护理,实验组采用1.5%双氧水和生理盐水行口腔冲洗+圆形海绵棒擦拭+西帕依固龈漱口液进行口腔护理。比较两组患者的口腔清洁度、舒适度、伤口愈合情况及患者满意度。结果:实验组在增加口腔清洁程度、减轻口臭、减少组织瓣移植区分泌物、促进伤口愈合等方面均优于对照组,患者满意度得到提高,差异具有统计学意义(P<0.05)。结论:用口内冲洗消毒法对舌癌术后患者进行口腔护理,可有效预防口腔感染,增加舒适度,提高患者满意度,促进患者康复。     

保留牙列和下颌骨行舌癌根治术的近期疗效观察

目的:为提高舌癌患者术后生存质量,探讨保留牙列和下颌骨的舌癌改良根治方法,并评价其疗效。方法:回顾性分析采用保留牙列和下颌骨方式行舌癌根治术的13例T2期舌癌患者的临床资料,通过术后肿瘤有无复发和转移,患者面形、咬合、舌运动、语言和进食等情况,评价手术疗效和患者口腔功能状况。结果:随访3～23个月,1例患者肿瘤转移,其余12例患者未发现肿瘤局部复发和远处转移。全部患者术后均无咬合错乱,语言、咀嚼功能良好,面部对称无畸形。结论:保留牙列和下颌骨的舌癌改良根治方法能够获得良好的舌癌治疗效果并保存面形和口腔功能,但须选择相应的手术适应证。     

应用赝复体修复上颌牙列缺损伴上颌骨缺损临床效果评价

目的　评价应用赝复体修复上颌牙列缺损伴上颌骨缺损的临床效果。方法　选取2017年10月至2019年12月于中国医科大学附属口腔医院口腔颌面外科因口腔颌面部肿瘤切除单侧上颌骨并需赝复体修复患者16例。比较患者赝复体修复前和赝复体修复后2个月的咀嚼效率,并采用华盛顿大学生存质量问卷（University of Washington quality of life questionnaire,UW-QOL）评价患者赝复体修复后2个月的生存质量。结果　赝复体修复前和赝复体修复后2个月患者的咀嚼效率分别为（52.5 ± 10.5）%和（69.8 ± 11.1）%,其差异有统计学意义（t = 11.31,P < 0.05）。经UW-QOL评价发现,患者对各项评分均较高,其中疼痛为（89.1 ± 12.8）分,吞咽为（87.5 ± 15.8）分,咀嚼为（84.4 ± 18.0）分,这三项的患者主观感受更好。结论　应用赝复体修复上颌牙列缺损伴上颌骨缺损的临床效果较好,可提高患者的生存质量。     

应用赝复体修复上颌牙列缺损伴上颌骨缺损临床效果评价

 目的　评价应用赝复体修复上颌牙列缺损伴上颌骨缺损的临床效果。方法　选取2017年10月至2019年12月于中国医科大学附属口腔医院口腔颌面外科因口腔颌面部肿瘤切除单侧上颌骨并需赝复体修复患者16例。比较患者赝复体修复前和赝复体修复后2个月的咀嚼效率,并采用华盛顿大学生存质量问卷（University of Washington quality of life questionnaire,UW-QOL）评价患者赝复体修复后2个月的生存质量。结果　赝复体修复前和赝复体修复后2个月患者的咀嚼效率分别为（52.5 ± 10.5）%和（69.8 ± 11.1）%,其差异有统计学意义（t = 11.31,P < 0.05）。经UW-QOL评价发现,患者对各项评分均较高,其中疼痛为（89.1 ± 12.8）分,吞咽为（87.5 ± 15.8）分,咀嚼为（84.4 ± 18.0）分,这三项的患者主观感受更好。结论　应用赝复体修复上颌牙列缺损伴上颌骨缺损的临床效果较好,可提高患者的生存质量。     

射频热凝术联合注射阿霉素治疗三叉神经下颌支痛的临床研究

目的 评价3D打印模板引导射频热凝术联合注射阿霉素治疗三叉神经下颌支痛的临床应用价值。方法将2019年1月—2020年9月在郑州市口腔医院接受射频热凝治疗的50例原发性三叉神经下颌支痛患者随机分为2组,以3D打印模板引导射频热凝术联合注射阿霉素为研究组（n=25）,以3D打印模板单纯辅助射频热凝术为对照组（n=25）,对比分析2组患者术前,术后即刻及术后1、3、6、12个月时的疼痛情况,即视觉模拟评分（VAS）。采用Brisman三叉神经疼痛疗效评定标准对术后各随访时间段的治疗效果进行评估,并记录术后并发症的情况。结果 2组患者术后即刻VAS及术后1、3、6、12个月时的VAS与术前比较均明显下降,差异均有统计学意义（P<0.05）;根据Brisman三叉神经痛疗效评定标准,2组患者在术后1和3个月时的有效性差异无统计学意义（P>0.05）;术后6和12个月时,研究组的有效性高于对照组,差异均有统计学意义（P<0.05）。研究组患者在随访期间无复发病例,对照组患者在术后3个月时复发1例,术后6个月时复发2例,术后12个月时复发4例;2组患者均未出现明显并发症。结论 3...     

基于体验的护患协同设计在头颈部肿瘤术后患者家庭肠内营养中的应用

目的 ：探讨基于体验的护患协同设计（experience-based co-design,EBCD）在头颈部肿瘤术后患者家庭肠内营养中的应用效果。方法：选取上海交通大学医学院附属第九人民医院2021年5月—9月治疗的41例头颈部肿瘤患者为对照组,采用常规肠内营养健康教育和出院指导;2021年10月—2022年3月治疗的41例头颈部肿瘤患者为试验组,在对照组基础上实施基于EBCD的家庭肠内营养护理服务,比较2组患者出院前及出院1个月、3个月的营养状况、自我管理效能及生活质量。采用SPSS 20.0软件包对数据进行统计学分析。结果：出院3个月后,试验组患者主观整体评估量表（PG-SGA）评分优于对照组,血红蛋白、血清白蛋白、血清总蛋白水平显著高于对照组（P<0.05）。出院1个月、3个月,试验组患者自我管理效能及生活质量评分优于对照组;2组比较,干预效应、时间效应、交互效应均有统计学差异（P<0.05）。结论：基于EBCD的家庭肠内营养护理以头颈部肿瘤患者体验为触点,改进家庭肠内营养护理服务质量,有效改善了患者营养状况、生活质量及自我管理效能。     

自我效能干预在口腔正畸治疗中的应用

目的 探讨自我效能干预对口腔正畸治疗患者心理状态的作用,建立合理的临床心理干预模式.方法 选择1 36例患者按照就诊顺序编号,奇数号入干预组(自我效能心理行为干预组),偶数号入对照组.对照组进行常规正畸知识教育,干预组增加自我效能干预.应用焦虑自评量表(SAS)、抑郁自评量表(SDS)、一般自我效能量感表(GSES)、Wong-Baker面部表情疼痛量表,对2组患者进行评估.结果 治疗第二个月复诊后1周,干预组疼痛总分低于对照组,差异有统计学意义(P＜0.05).治疗1个月后,SAS、SDS和GSES评分,干预组和对照组相比较,差异均有统计学意义(P＜0.05).治疗1年后,SAS、SDS和GSES评分,干预组和对照组相比较,差异均有统计学意义(P＜0.05).正畸治疗1年后进行正畸治疗满意度评定,干预组得分高于对照组,差异有统计学意义(P＜0.05).结论 对正畸治疗患者进行自我效能干预,可以显著降低心理卫生问题发生,提高正畸的疗效,增强治疗依从性,减轻疼痛.     

Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy

Tongue strength is reduced in patients treated with chemoradiotherapy for oral/oropharyngeal cancer. Tongue strengthening protocols have resulted in improved lingual strength and swallowing in healthy individuals, as well as in patients following a neurological event. However, no studies have examined the efficacy of tongue strengthening exercises on tongue strength, swallowing, and quality of life (QOL; Head and Neck Cancer Inventory) in patients treated with chemoradiotherapy. A randomized clinical trial examined the effects of a tongue strengthening programme paired with traditional exercises vs. traditional exercises alone. Dependent variables included tongue strength, swallowing, and QOL in a group of patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy. Differences with regard to tongue strength and oropharyngeal swallow efficiency (OPSE) were not observed within or between groups. QOL in the eating and speech domains improved following treatment in both groups. However, the experimental group demonstrated greater impairment in QOL in the social disruption domain following treatment, whereas the control group demonstrated a slight improvement in functioning. Tongue strengthening did not yield a statistically significant improvement in either tongue strength or swallowing measures in this patient cohort. Patient compliance and treatment timing may be factors underlying these outcomes.     

老年口腔肿瘤患者围手术期呼吸道护理

目的:探讨老年口腔肿瘤患者围手术期呼吸道护理。方法:选择我院2009年5月-2011年5月收治的老年口腔肿瘤行手术治疗的患者80例,随机分为两组,对照组40例采用常规护理,观察组40例在此基础上行围手术期整体护理干预,就两组临床资料进行回顾性分析。结果:观察组术后肺部感染1例,痊愈率为97.5%。对照组术后肺部感染5例,呼吸衰竭1例,痊愈率为85%,观察组临床治愈率明显优于对照组,差异有统计学意义,(P>0.05)。结论:老年口腔肿瘤患者加强围手术期护理干预,可显著提高临床治愈率,降低并发症发生率,改善患者生存质量。     

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目的比较接受不同重建方式的临床颈部阴性(cN0)舌癌患者的术后生存质量。方法将2006年7月至2008年7月在广东省口腔医院颌面外科治疗的舌癌患者36例,按游离皮瓣重建、带蒂胸大肌皮瓣重建方式分为两组,每组患者18例。游离皮瓣重建组患者接受肩胛舌骨上颈淋巴清扫术,舌部缺损采用游离桡侧前臂皮瓣或游离股前外侧皮瓣修复;带蒂胸大肌皮瓣重建组患者接受改良根治性颈淋巴清扫术,舌部缺损采用带蒂胸大肌皮瓣修复。术后12个月,采用4版华盛顿大学生存质量问卷(UW-QOL)对两组患者的生存质量进行评价。结果游离皮瓣重建组在生存质量总分及肩功能、活动、语音、吞咽分项目上得分均优于胸大肌皮瓣重建组。结论对于cN0舌癌患者,采用肩胛舌骨上颈淋巴清扫术和游离皮瓣重建能显著提高患者的术后生存质量。     

Preliminary study on the effect of oral care on recovery from surgery in elderly patients

This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.     

早期肠内营养支持对44例口腔口咽癌术后放化疗患者的影响

目的: 探讨放疗前2周进行肠内营养支持治疗对口腔口咽癌患者术后放化疗的营养状况及生活质量的影响。方法: 回顾性分析44例口腔口咽癌术后放化疗患者在不同时机进行营养干预后的营养状况及生活质量变化。将放疗前2周体重作为协变量,校正基线水平后,对观察指标体重、体质指数（BMI）及其与基线的变化值、主观整体营养状况评估（PG-SGA）等及生活质量评分量表（EORTC QLQ-C30及QLQ-H&N35）中整体健康状况、躯体功能和疲劳感3个方面分别进行评估。采用SPSS 19.0软件包,以重复测量方差分析分别对观察指标进行统计学分析。结果: 早期干预（即放疗开始前2周至放疗结束后2周给予肠内营养补充）25例,按需干预（即放疗3周后至放疗结束后2周给予肠内营养补充）19例。2组体重在放化疗期间整体均呈下降趋势,但早期干预组的下降程度更小（P=0.023）。2组PG-SGA在观察期间均出现较大幅度下降,早期干预组更显著（P=0.027）。2组整体健康状况总体上均好转,但患者均出现不同程度的疲劳感,躯体功能也不断下降,按需干预组更明显（P>0.05）。2组在放射性口腔黏膜炎程度分级上无统计学差异。结论: 口腔口咽癌患者术后放化疗期间的营养状况明显下降,早期肠内营养支持可在一定程度上维持体重,改善患者营养状况,但在提高患者生活质量方面未见明显优势。     

早期吞咽训练对舌癌术后吞咽障碍及生活质量的影响

目的：探讨早期吞咽训练对舌癌术后患者吞咽障碍的治疗效果及对生活质量的影响。方法：选择舌癌术后患者134例,年龄36~74岁,随机分层分为治疗组和对照组（各67例）,治疗组术后第10天开始进行10 d的吞咽训练,对照组不给予吞咽干预。采用吞咽筛查量表（10-Item Eating Assessment Tool,EAT-10）和肿瘤治疗功能评估—头颈问卷（中文版）（Functional Assessment of Cancer Therapy-Head and Neck,FACT-H&N）评价吞咽障碍程度和生活质量,记录吞咽训练前、后（术后10 d和20 d时）吞咽功能和生活质量的变化。采用SPSS13.0软件包进行组间比较及自身前后比较。EAT-10标准分与FACT-H&N总分之间作Pearson相关和线性回归分析。结果：治疗组吞咽训练后EAT-10标准分和FACT-H&N总分分别低于和高于治疗前（P＜0.05）;对照组术后10 d与术后20 d两组量表之间差异无统计学意义（P＞0.05）;治疗组吞咽训练后EAT-10标准分和FACT-H&N总分分别低于和高于对照组术后20 d（P＜0.05）。EAT-10标准分和FACT-H&N总分之间存在负相关（P＜0.01）。结论：早期吞咽训练有助于提高舌癌术后患者的吞咽功能和生活质量。     

加速康复外科在口腔癌患者术后早期康复中的应用效果评价

目的: 探讨加速康复外科（enhanced recovery after surgery, ERAS）在口腔癌患者术后早期康复中的应用效果。方法: 将2016年1月—2017年12月收治的90例口腔癌患者随机分为2组,试验组45例,术后行ERAS护理;对照组45例,术后给予常规护理。比较2组患者术后3 d日均睡眠时间,中度及以上疼痛及口臭发生情况;首次下床时间、术后住院时间;术后1、3 d前白蛋白等实验室指标。采用SPSS 17.0软件包对数据进行统计学分析。结果: ERAS干预后,术后1、3 d营养指标下降低于对照组;患者首次下床活动时间、术后住院天数均短于对照组,术后3 d睡眠时间长于对照组;发生口臭、伤口感染、中度疼痛的人次数低于对照组,差异有统计学意义（P<0.05）。结论: 口腔癌患者术后实施ERAS护理,可以提高患者舒适度,改善临床结局,促进患者快速康复,具有较好的临床应用前景。     

Sensory outcomes of the anterior tongue after lingual nerve repair in oropharyngeal cancer

Primary treatment of oropharyngeal cancer often involves surgical resection and reconstruction of the affected area. However, during base of tongue reconstruction the lingual nerve is often severed on one or both sides, affecting sensation in the preserved tissue of the anterior tongue. The loss of specific tongue sensations could negatively affect a person's oral function and quality of life. The aim of this study was to explore the effects of different types of lingual nerve intervention on sensory function for patients with base of tongue cancer as compared to healthy, age-matched adults. Subjects included 30 patients who had undergone primary oropharyngeal reconstruction with a radial forearm free-flap and 30 matched controls. Sensations tested were temperature, two-point discrimination, light touch, taste, oral stereognosis and texture on the anterior two-thirds of the tongue. Results indicated that type of surgical nerve repair may not have a significant impact on overall sensory outcomes, providing mixed results for either nerve repair technique. Sensations for the nonoperated tongue side and operated side with lingual nerve intact were comparable to matched controls, with mixed outcomes for nerve repair. The poorest sensory outcomes were observed in patients with the lingual nerve severed, while all patients with lingual nerve intervention exhibited deteriorated taste sensation on the affected tongue side. Overall, patients in this study who had undergone oropharyngeal reconstruction with lingual nerve intervention exhibited decreased levels of sensation on the operated tongue side, with minimal differences between types of lingual nerve repair.     

吞咽训练在口腔癌术后加速康复中的效果评价

目的: 评估吞咽训练对口腔癌根治术后患者早期吞咽功能影响及影响吞咽训练效果的相关因素。方法: 对31例接受手术治疗后具有吞咽障碍的口腔癌患者进行吞咽训练,评估,记录患者吞咽训练前、后洼田饮水试验评级、 曼恩评分及舌肌评级。吞咽训练后行吞咽造影,明确吞咽功能,指导拔除鼻饲管。采用SPSS 12.0软件包对数据进行统计学分析。结果: 31例患者口腔癌根治术后经过吞咽训练,吞咽功能短期内得到显著提高,洼田饮水试验评级、曼恩评分及舌肌评级在训练前、后均有统计学差异(P<0.05)。肿瘤T分期是唯一显著影响患者吞咽预后的因素（P=0.029）。另外,患者术后拔除鼻饲管时间平均为术后7.6 d。结论: 口腔癌根治术后患者的吞咽障碍在接受早期吞咽训练后能得到显著改善,患者吞咽障碍的早期诊断及介入训练对预后有积极影响,为患者拔除鼻饲管、安全经口进食提供了可靠的依据。     

A subjective comparison of two lingual bracket systems

The purpose of this prospective, longitudinal study was to compare the influence of two lingual bracket systems on subjective oral comfort, speech, mastication and oral hygiene. Forty-two native speakers of standard German (32 females, 10 males; mean age 27.1 years, standard deviation 12.2) were enrolled and completed a standardized questionnaire directly before insertion of lingual brackets (T0), within 24 hours of bond-up (T1) and 3 months (+/- 1 week) later (T2). Eighteen of the patients were treated with prefabricated brackets (Ormco, seventh generation) (PB group) and 24 with customized brackets (Incognito) (CB group).While no significant intergroup differences were recorded at any of the times with respect to tongue position, conversation pattern, swallowing or oral hygiene, the CB group experienced significantly fewer tongue space restrictions, speech disturbances and impairments in chewing and biting than the PB group at T1 and T2. At T2, pressure sores, reddening or lesions to the tongue were recorded significantly less often in the CB group than in the PB group.This enhanced patient comfort in the CB group was attributed to the smaller dimensions of the customized brackets. This aspect could play a role in attracting more patients to lingual orthodontics in the future. Information given to the patient on the duration and extent of the restrictions associated with lingual orthodontics must be differentiated according to the bracket system used.