Article record

口咽吞咽困难患者进餐管理的应做与不应做：意大利吞咽学学会改良德尔菲共识研究

Do's and Don'ts in Mealtime Management for People with Oropharyngeal Dysphagia: A Modified Delphi Consensus Study from the Italian Society of Deglutology.

指南共识咽喉科IF 6.5Q1

文献信息

PMID	42884720
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Nicole Pizzorni 查看其他 54 位作者 Sara Rocca；Aurora Ninfa；Antonio Amitrano；Arianna Valeria Bai；Michela Barichella；Maria Rosaria Barillari；Umberto Barillari；Jessica Barsotti；Irene Battel；Monica Bianchi；Alessandra Bosetti；Paola Castellini；Federica Cenci；Emanuele Cereda；Anna Colombo；Antonella Cusimano；Francesco D'Abrosca；Ramona De Amicis；Claudia Dellavia；Antonella Delle Fave；Stefano Doratiotto；Daniele Farneti；Bruno Fattori；Maria Luisa Fiorella；Alessandro Galazzi；Federica Lucia Galli；Elisabetta Genovese；Luisa Gervasio；Silvia Gnecchi；Isabella Koch；Valentina Lamon；Patrizia Maruzzi；Benito Michelizza；Maria Giulia Montecchi；Luca Morelli；Francesco Mozzanica；Luca Parisi；Carlo Pedrolli；Gaia Pellegrini；Chiara Piscitelli；Marco Ramaioli；Cristina Reverberi；Sergio Riso；Giovanni Ruoppolo；Amelia Santoro；Alessandro Selvagio；Massimo Spadola Bisetti；Chiara Stracquadanio；Beatrice Travalca Cupillo；Stefano Usai；Elvira Verduci；Irene Vernero；Lucia Zannini；Antonio Schindler
作者单位	Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy. 查看其他 48 条单位信息 Phoniatric and Speech and Language Pathologist Unit, Vittore Buzzi Children's Hospital, 20154 Milan, Italy.；Degree Courses in Health Professions "Luigi Sacco" Hospital, University of Milan, 20157 Milan, Italy.；Independent Researcher, 20154 Milan, Italy.；Developmental Neuroscience Clinical Department, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy.；Clinical Nutrition Unit, ASST Gaetano Pini-CTO, 20126 Milan, Italy.；Fondazione Pezzoli per la Malattia di Parkinson, 20125 Milan, Italy.；Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.；Department of Child Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56128 Pisa, Italy.；Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy.；Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), CH-6928 Manno, Canton Ticino, Switzerland.；Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy.；Phoniatric Unit, IRCCS AOM-Policlinico San Martino, 16132 Genoa, Italy.；Occupational Therapy Service, Intermediate Care Unit, Health and Social Care Department, ASP Golgi-Redaelli, 20146 Milan, Italy.；Clinical Nutrition and Dietetics Unit, Fondazione IRCCS San Matteo, 27100 Pavia, Italy.；Department of Health Sciences, University of Eastern Piedmont Amedeo Avogadro, 28100 Novara, Italy.；Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy.；Department of Endocrine and Metabolic Diseases, Obesity Unit and Laboratory of Nutrition and Obesity Research, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy.；Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.；Department of Diagnostic and Interventional Radiology, Ca' Foncello Hospital, 31100 Treviso, Italy.；Audiologic Phoniatric Service, ENT Department AUSL Romagna, Infermi Hospital, 47923 Rimini, Italy.；ENT, Audiology, and Phoniatrics Unit, University Hospital of Pisa, University of Pisa, 56124 Pisa, Italy.；Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", 70124 Bari, Italy.；Department of Medicine and Surgery, LUM University, 70010 Casamassima, Italy.；Department of Experimental and Clinical Medicine, Marche Polytechnic University, 60126 Ancona, Italy.；Former, Audiology Program, Department of Maternal, Child and Adult Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy.；Pharmacy Service, I.R.C.C.S. Foundation Istituto Neurologico Nazionale C. Mondino, 27100 Pavia, Italy.；IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.；Independent Researcher, Lido, 30126 Venice, Italy.；Clinical Nutrition Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy.；Istituto Molisano di Riabilitazione, 86039 Termoli, Italy.；Neurorehabilitation Unit, Dipartimento Neuromotorio Riabilitativo, Ospedale San Sebastiano, Correggio, Ausl-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy.；Department of Audiovestibology-Cochlear Implant Center, ASST Sette Laghi, 21100 Varese, Italy.；Department of Otorhinolaryngology, IRCCS Multimedica, Ospedale San Giuseppe, 20123 Milan, Italy.；Department of Clinical Sciences and Community Health (Department of Excellence 2023-2027), University of Milan, 20122 Milan, Italy.；Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT), Santa Chiara Hospital, 38122 Trento, Italy.；Neonatal and Pediatric Department, ASL Roma 6, 00041 Albano Laziale, Italy.；Université Paris-Saclay, INRAE, AgroParisTech, UMR SayFood, 91120 Palaiseau, France.；Azienda USL IRCSS di Reggio Emilia, 42123 Reggio Emilia, Italy.；Dietetic and Clinical Nutrition Unit, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy.；Former, Sapienza Università di Roma, 00185 Rome, Italy.；A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy.；ASST GOM Niguarda, 20162 Milan, Italy.；Former, Phoniatric Unit, IRCCS AOM-Policlinico San Martino, 16132 Genoa, Italy.；Centro Studi Riabilitazione Neurocognitiva di Villa Miari, 36014 Santorso, Italy.；Department of Health Sciences, University of Milan, 20146 Milan, Italy.；Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.；Former, University of Turin, 10124 Turin, Italy.；Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy.
期刊	Nutrients
SCI 分区	Q1
IF	6.5
研究类型	指南共识 · 临床
所属专科	咽喉科

中文摘要

背景： 进餐是日常生活、健康和社交参与的核心，但口咽吞咽困难（OD）患者的进餐安全性和愉悦感可能受到影响。尽管OD对躯体与心理社会健康及日常功能有广泛影响，临床实践中仍缺乏针对全面进餐管理的结构化指导。为填补这一空白，制定了一套基于专家共识的“应做与不应做”建议，涵盖四个与进餐相关的领域。方法：由意大利吞咽学学会推动的一项改良德尔菲共识研究，纳入了53名OD及相关学科的多学科专家小组。专家们围绕四个领域制定“应做”和“不应做”陈述：以营养为重点的饮食处方、餐食准备、进餐体验以及患者和照护者教育。经小组召集人审核后，61条陈述采用3点序数量表并附加“无法表达意见”选项进行了两轮在线投票。共识预先定义为一致率≥75%。两轮之间根据参与者意见对陈述进行修订，以确保临床准确性和实际适用性。结果：第一轮应答率为85%，第二轮为97.8%。第二轮后，61条陈述中有57条（93.4%）达到共识阈值（一致率≥75%）。结论：OD的进餐管理应个体化并以人为中心，平衡吞咽安全、营养需求、生活质量和进食愉悦感。管理不应仅限于代偿策略，还应包括进餐的社会和关系维度。患者和照护者的积极参与和教育对于支持治疗依从性和建议的日常实施至关重要。跨专业协作和多模式教育策略对于确保OD照护中协调、安全且有效的营养方案至关重要。

英文摘要

Background: Meals are central to daily life, health, and social participation, yet their safety and enjoyment can be compromised in people with oropharyngeal dysphagia (OD). Despite the broad impact of OD on physical and psychosocial well-being and daily functioning, structured guidance for comprehensive mealtime management in clinical practice is lacking. To address this gap, a set of expert consensus-based "Do's and Don'ts" covering four meal-related domains was developed. Methods: A modified Delphi consensus study promoted by the Italian Society of Deglutology involved a multidisciplinary panel of 53 experts in OD and related disciplines. Experts developed "Do" and "Don't" statements across four domains: nutrition-focused diet prescription, meal preparation, mealtime experience, and patient and caregiver education. After panel conveners' review, 61 statements underwent two rounds of online voting using a 3-point ordinal scale plus an additional option 'unable to express an opinion'. Consensus was predefined as ≥75% agreement. Statements were revised between rounds based on participants' comments to ensure clinical accuracy and practical applicability. Results: The response rate was 85% for Round 1 and 97.8% for Round 2. After Round 2, 57 of 61 statements (93.4%) reached the consensus threshold (≥75% agreement). Conclusions: Mealtime management in OD should be individualized and person-centered, balancing swallowing safety, nutritional requirements, quality of life, and enjoyment of eating. Management should extend beyond compensatory strategies alone to include the social and relational dimensions of meals. Active involvement and education of patients and caregivers are essential to support therapeutic adherence and daily implementation of recommendations. Interprofessional collaboration and multimodal educational strategies are crucial to ensuring a coordinated, safe, and effective nutritional approach to OD care.