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題名 | 使用吞嚥內視鏡評估腦中風吞嚥障礙病人使用下頜回收法之效益=The Effects of Chin-tuck Position in Stroke Patient with Dysphagia Evaluated by Fiberoptic Endoscopy |
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作者 | 陳昱諭; 陳天文; 黃茂雄; | 書刊名 | 臺灣復健醫學雜誌 |
卷期 | 43:1 2015.03[民104.03] |
頁次 | 頁1-7 |
分類號 | 415.822、415.822 |
關鍵詞 | 腦中風; 吞嚥內視鏡; 吞嚥困難; 下頜回收法; Stroke; Fiberoptic endoscopic evaluation of swallowing; Dysphagia; Chin-tuck; |
語文 | 中文(Chinese) |
中文摘要 | 目的:以吞嚥內視鏡作為評估,探討腦中風病人在使用下頜回收法後吞嚥功能之變化及其三個月後的預後。方法:對34位腦幹或非腦幹中風以鼻胃管灌食之吞嚥困難的病人,以吞嚥內視鏡作為評估工具,比較病人採取下頜回收法前後,病人吞嚥障礙特徵之改變,包括食團滯留位置情形、吞嚥困難嚴重度量表的變化,隨後以電話追蹤三個月後病人是否仍使用鼻胃管,是否有呼吸道感染以及三個月後病人體重和腦中風初時體重是否有明顯變化(超過5公斤或10%入院體重)。結果:使用下頜回縮法對於非腦幹中風的病人可以減少食團滯留及內視鏡吞嚥困難嚴重度量表的嚴重度,使用下頜回縮法對於腦幹中風的病人亦可以減低吞嚥困難嚴重度量表的嚴重度。且在三個月的追蹤發現,使用下頜回縮法在吞嚥內視鏡下有改善的病人,三個月後移除鼻胃管的成功率較高。結論:對於腦中風併有吞嚥困難的病人,使用吞嚥內視鏡進行吞嚥功能的基本評估,可以幫助臨床醫師了解病人吞嚥障礙特徵以及選擇適合的吞嚥代償方式。下頜回收法對於非腦幹中風的病人是較適合的吞嚥代償方式,在吞嚥內視鏡下,可以發現立即顯著進步,且使用下頜回收法在內視鏡吞嚥困難嚴重度量下有改善的病人,三個月後移除鼻胃管的成功率顯著較高。 |
英文摘要 | Background and Purpose: Dysphagia is a frequent symptom after stroke. Dysphagia increases the risk of aspiration pneumonia, malnutrition, and is associated with poor prognosis. Fiberoptic endoscopic evaluation of swallowing (FEES) is a suitable method for dysphagia assessment after acute stroke. Chin-tuck position has been used in dysphagia patients to prevent aspiration during swallowing. But the combined application of these promising modalities has rarely been studied. We aimed to evaluate the effects of chin-tuck position in stroke patient with dysphagia evaluated by fiberoptic endoscopy. Methods: A total of 34 consecutive patients with first stroke were enrolled. FEES after swallowing was done before and after chin-tuck position for evaluation. The dysphagia was measured by the pharyngeal stasis condition and the fiberoptic endoscopic dysphagia severity scale (FEDSS). A telephone interview was arranged in 3 months. The patients were asked about body weight change, respiratory tract infection events and nasogastric tube (NG tube) usage. Results: In the patients with extra-brainstem stroke, the pharyngeal stasis condition and FEDSS improved significantly with chin-tuck position. Furthermore, the brainstem stroke patient had better FEDSS with chin-tuck position. The 3-month NG tube removal rate was better in the patients who had better FEDSS. Conclusion: A baseline FEES examination provides valuable prognostic information for the choice of dysphagia managementin acute stroke patients. Chin-tuck is a better management of dysphagia in patients with extra-brainstem stroke. The 3-month NG tube removal rate was increased in the patients who had less severity by FEDSS. |
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