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| 題 名 | 提升急性呼吸衰竭病人拔管後吞嚥功能暨預防吸入性肺炎發生=Improving Swallowing Function and Preventing Aspiration Pneumonia in Post-Extubation Patients with Acute Respiratory Failure |
|---|---|
| 作 者 | 曾榮賦; 陳欽明; 黃惠美; 陳奇祥; 李書琦; 周偉倪; | 書刊名 | 台灣急重症醫學雜誌 |
| 卷 期 | 10:2 2025.06[民114.06] |
| 頁 次 | 頁53-62 |
| 分類號 | 415.47 |
| 關鍵詞 | 急性呼吸衰竭; 加護病房; 吞嚥功能; 吸入性肺炎; Acute respiratory failure; Intensive care unit; Swallowing function; Aspiration pneumonia; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 背景:病人由急診、病房或開刀術後因急性呼吸衰竭插管住入加護病房 (intensive care unit, ICU), 病人插管大於 48 小時後容易有插管後吞嚥困難,期望介入口咽吞嚥復健及預防措施,讓病人拔管後在 ICU 時可以盡早移除鼻胃管,降低家屬後續照顧負荷。 方法:我們選定各一個內、外科成人 ICU,共 20 床。以「課題達成型」及「風險管理 - 危害分析表」 為品管手法,掌握項目方面,選定「5W1H」,依最高分數共選出 6 項做為掌握項目,並依期望水準及現 況水準分析望差值,再選出 6 項攻堅點進行一次及二次展開,最終選定 12 項方策。此外檢視高風險流 程的過程中,進行危害分析,最後形成 3 項行動方案。 結果:病人吞嚥功能之由口進食量表 (Functional Oral Intake Scale, FOIS) 分數≥ 5 分比率,在內外科 ICU 分別由改善前 28% 及 45%,提升改善後為 100% 及 71%。造成吸入性肺炎發生率由改善前 1.3‰, 降至改善中 0‰,改善後維持 0‰。轉出 ICU 鼻胃管留置比率由改善前 37%,降至改善中 21%,降至改 善後 18%。而病人管灌膳食費用大幅度降低 75%。 結論:本圈運作期間我們跨領域結合耳鼻喉科醫師及語言治療師,又帶給重症插管病人一項新的契 機,讓病人可早期與預防插管後造成的吞嚥困難,甚至降低鼻胃管留置,也降低家屬照顧負荷及病人的 自卑感。 |
| 英文摘要 | Background: We tried to perform interventions to improve the condition of patients with the acute respiratory failure who are intubated and admitted to the intensive care unit (ICU), enabling early removal of the nasogastric tube (NG tube) while still in the ICU. Methods: Among adult ICU for internal and surgical patients in Chi-Mei Medical Center, a “task achievement model” was employed as a quality control tool. This integrated three major intervention groups: 1. Swallowing assessment; 2. Swallowing training intervention; 3. Adaptability and responsiveness. The goal was to improve swallowing function, reduce the incidence of aspiration pneumonia, and decrease the rate of NG tube retention. Results: The percentage of internal and surgical ICU patients with a Functional Oral Intake Scale (FOIS) score of ≥5 increased from 28% and 45% to 100% and 71%, respectively. The incidence of aspiration pneumonia decreased from 1.3‰ to 0. The rate of NG tube retention upon ICU discharge decreased from 37% to 18%. Additionally, patient enteral nutrition costs were significantly reduced by 75%. Conclusion: Quality control interventions can significantly improve and prevent swallowing difficulties caused by intubation in ICU patients. |
本系統中英文摘要資訊取自各篇刊載內容。