Abstract：
Determine the safety and effectiveness of a nasogastric tube removal plan designed to shorten nasogastric tube indwelling time after oral cancer surgery plus free flap reconstruction.
A parallel randomized clinical trial was conducted from May 2021 to December 2021 at Peking University School of Stomatology. Volunteers (n = 128) were separated into four groups: non-tracheostomy control and intervention groups and tracheostomy control and intervention groups. Control patients received the conventional nasogastric tube removal plan. Non-tracheotomy intervention patients were asked to swallow 5 ml of water on the first postoperative day. If there was no coughing, they were allowed progressively increasing amounts of water for the following 2 days. The nasogastric tube was removed only after ensuring level I/II performance on the Watian water swallowing test, no \"wet voice\" after drinking water, no marked decrease in blood oxygen saturation after drinking, and satisfactory daily oral nutritional intake. Tracheotomy intervention patients received the same protocol plus an additional Watian water swallowing test after tracheal tube removal.
Nasogastric tube removal time was earlier in the intervention subgroups than in control subgroups: 5.0 ± 2.3 days versus 7.8 ± 3.9 days (p = 0.001) in non-tracheostomy patients and 9.8 ± 1.1 days versus 16.2 ± 13.0 days (p = 0.049) in tracheostomy patients. Incidence of wound complications and daily food intake were comparable between the groups. The incidence of pneumonia was lower in the tracheostomy intervention group than in the tracheostomy control group (12.5% vs. 3.1%, p = 0.162). Pharyngeal pain score was lower in tracheotomy intervention patients than in tracheotomy control patients (p = 0.029). Postoperative hospital stay was shorter in tracheotomy intervention patients than in tracheotomy control patients (p = 0.005).
On the basis of ensuring safety and effectiveness, patients undergone free flap reconstruction for oral cancer could be offered oral intake early after surgery, which will not increase the incidence of wound complications and pneumonia or adversely affecting the oral intake of the patients; it can also help minimize pharyngeal pain and shorten postoperative hospital stay of patients with a tracheotomy.
2 Laryngoscope, 133:1382-1387, 2023.
A parallel randomized clinical trial was conducted from May 2021 to December 2021 at Peking University School of Stomatology. Volunteers (n = 128) were separated into four groups: non-tracheostomy control and intervention groups and tracheostomy control and intervention groups. Control patients received the conventional nasogastric tube removal plan. Non-tracheotomy intervention patients were asked to swallow 5 ml of water on the first postoperative day. If there was no coughing, they were allowed progressively increasing amounts of water for the following 2 days. The nasogastric tube was removed only after ensuring level I/II performance on the Watian water swallowing test, no \"wet voice\" after drinking water, no marked decrease in blood oxygen saturation after drinking, and satisfactory daily oral nutritional intake. Tracheotomy intervention patients received the same protocol plus an additional Watian water swallowing test after tracheal tube removal.
Nasogastric tube removal time was earlier in the intervention subgroups than in control subgroups: 5.0 ± 2.3 days versus 7.8 ± 3.9 days (p = 0.001) in non-tracheostomy patients and 9.8 ± 1.1 days versus 16.2 ± 13.0 days (p = 0.049) in tracheostomy patients. Incidence of wound complications and daily food intake were comparable between the groups. The incidence of pneumonia was lower in the tracheostomy intervention group than in the tracheostomy control group (12.5% vs. 3.1%, p = 0.162). Pharyngeal pain score was lower in tracheotomy intervention patients than in tracheotomy control patients (p = 0.029). Postoperative hospital stay was shorter in tracheotomy intervention patients than in tracheotomy control patients (p = 0.005).
On the basis of ensuring safety and effectiveness, patients undergone free flap reconstruction for oral cancer could be offered oral intake early after surgery, which will not increase the incidence of wound complications and pneumonia or adversely affecting the oral intake of the patients; it can also help minimize pharyngeal pain and shorten postoperative hospital stay of patients with a tracheotomy.
2 Laryngoscope, 133:1382-1387, 2023.
摘要：
目的：确定旨在缩短口腔癌手术加游离皮瓣重建后鼻胃管留置时间的鼻胃管拔除计划的安全性和有效性。
方法：一项平行随机临床试验于2021年5月至2021年12月在北京大学口腔医学院进行。志愿者（n=128）分为四组：非气管造口术对照组和干预组和气管造口术对照组和干预组。对照组患者接受常规鼻胃管拔除计划。非气管切开介入患者在术后第一天被要求吞咽5ml水。如果没有咳嗽,在接下来的2天内，他们被允许逐渐增加水量。只有在确保瓦田水吞咽试验的I/II级性能后，才取出鼻胃管。喝水后没有“湿声音”，饮酒后血氧饱和度没有明显下降，和令人满意的每日口服营养摄入量。气管切开术干预患者在气管导管拔除后接受了相同的方案以及额外的Watian水吞咽测试。
结果：干预亚组的鼻胃管拔除时间早于对照组：非气管造口术患者5.0±2.3天比7.8±3.9天（p=0.001），气管造口术患者9.8±1.1天比16.2±13.0天（p=0.049）。两组之间伤口并发症的发生率和每日食物摄入量具有可比性。气管造口干预组的肺炎发生率低于气管造口对照组（12.5％vs.3.1%,p=0.162）。气管切开术干预患者的咽部疼痛评分低于气管切开术对照组患者（p=0.029）。气管切开干预患者的术后住院时间短于气管切开对照组患者（p=0.005）。
结论：在确保安全性和有效性的基础上，经游离皮瓣重建口腔癌的患者可以在手术后早期给予口腔摄入，这不会增加伤口并发症和肺炎的发生率，也不会对患者的口腔摄入量产生不利影响；它还有助于减少咽部疼痛，缩短气管切开患者的术后住院时间。
方法：II喉镜，2022年。
方法：一项平行随机临床试验于2021年5月至2021年12月在北京大学口腔医学院进行。志愿者（n=128）分为四组：非气管造口术对照组和干预组和气管造口术对照组和干预组。对照组患者接受常规鼻胃管拔除计划。非气管切开介入患者在术后第一天被要求吞咽5ml水。如果没有咳嗽,在接下来的2天内，他们被允许逐渐增加水量。只有在确保瓦田水吞咽试验的I/II级性能后，才取出鼻胃管。喝水后没有“湿声音”，饮酒后血氧饱和度没有明显下降，和令人满意的每日口服营养摄入量。气管切开术干预患者在气管导管拔除后接受了相同的方案以及额外的Watian水吞咽测试。
结果：干预亚组的鼻胃管拔除时间早于对照组：非气管造口术患者5.0±2.3天比7.8±3.9天（p=0.001），气管造口术患者9.8±1.1天比16.2±13.0天（p=0.049）。两组之间伤口并发症的发生率和每日食物摄入量具有可比性。气管造口干预组的肺炎发生率低于气管造口对照组（12.5％vs.3.1%,p=0.162）。气管切开术干预患者的咽部疼痛评分低于气管切开术对照组患者（p=0.029）。气管切开干预患者的术后住院时间短于气管切开对照组患者（p=0.005）。
结论：在确保安全性和有效性的基础上，经游离皮瓣重建口腔癌的患者可以在手术后早期给予口腔摄入，这不会增加伤口并发症和肺炎的发生率，也不会对患者的口腔摄入量产生不利影响；它还有助于减少咽部疼痛，缩短气管切开患者的术后住院时间。
方法：II喉镜，2022年。
