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題名:復建期腦中風病患咀嚼吞嚥障礙盛行率及初步篩檢徵象之探討
書刊名:護理雜誌
作者:何怡慧劉秀月黃純德
作者(外文):Ho, Yi-huiLiu, Hsiu-yuehHuang, Shun-te
出版日期:2014
卷期:61:2
頁次:頁54-62
主題關鍵詞:腦中風咀嚼吞嚥障礙反覆性唾液吞嚥試驗法改良式喝水測試StrokeDysphagiaRepetitive saliva swallowing testRSSTModified water swallowing testMWST
原始連結:連回原系統網址new window
相關次數:
  • 被引用次數被引用次數:期刊(9) 博士論文(1) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:9
  • 共同引用共同引用:6
  • 點閱點閱:51
背景:咀嚼吞嚥障礙是腦中風病患常見的障礙之一,且伴隨許多併發症,如吸入性肺炎、營養失調、住院天數增加等。綜觀國內外的研究,多是針對急性期來探討咀嚼吞嚥障礙及其對預後的影響,針對轉入復健期後的病患咀嚼吞嚥障礙的評估應持續進行但其相關研究卻較少。目的:探討復健期腦中風病患的咀嚼吞嚥障礙盛行率及咀嚼吞嚥障礙徵象指標。方法:本研究以方便取樣於南部某醫學中心之復健科病房進行收案,符合收案條件者進行基本資料收集及臨床相關檢查資料之蒐集,以反覆性唾液吞嚥試驗法(repetitive saliva swallowing test, RSST)與改良式喝水測試(modified water swallowing test, MWST)來評估病患是否有咀嚼吞嚥障礙,咀嚼吞嚥障礙的定義為無法完成RSST或MWST其中一種測試。本研究採用JMP 9.0進行資料統計分析,包括描述性統計、t檢定、卡方檢定與邏輯迴歸分析。結果:本研究結果顯示53.61%的病患有咀嚼吞嚥障礙。「是否可以緊閉嘴唇含水」、「會咀嚼但無法咬碎」、「吞嚥後食物是否卡在喉嚨」、「吞嚥後是否有痰液聲出現」、「喝水是否嗆咳」這五種與咀嚼吞嚥障礙有關的徵象呈現出顯著性差異。進一步以多變項邏輯迴歸分析結果顯示「喝水是否嗆咳」為咀嚼吞嚥障礙之重要指標。結論:中風後的復健期,仍有半數以上病患有咀嚼吞嚥障礙的表現,第一線照護病患的護理人員,亦須同時具備咀嚼吞嚥障礙相關的知識與訓練,以提升病患照護安全。
Background: Dysphagia, a very common post-stroke symptom, has been linked to aspiration pneumonia, malnutrition, and increased length of hospitalization. While patients are typically monitored for dysphagia continuously following their transfer to a rehabilitation unit, little is known about the results of dysphagia reassessments.Purpose: This study investigates the prevalence and signs of dysphagia among stroke patients in rehabilitation units.Methods: We analyzed patients with stroke admitted to a rehabilitation unit of a medical center in southern Taiwan. The procedure included chart review, the repetitive saliva swallowing test (RSST), and the modified water swallowing test (MWST). Dysphagia was defined as either RSST or MWST abnormal. JMP 9.0 was used to perform descriptive statistics, t-test, chi-square test and logistic regression analysisResults: At clinical examination, 53.61% of the study subjects demonstrated dysphagia. Chi-square analysis showed that five abnormal signs (could not close mouth with water, without mastication, food stuck in the throat, obvious sputum sound, and choking after swallowing) are all associated with dysphagia. Multiple logistic regression analysis revealed choking is a significant predictor variable of dysphagia.Conclusion: Over half of the rehabilitation unit stroke patients in this study had dysphagia. Nurses are the primary care providers for dysphagia patients. Therefore, there is a need for ward nurses to have skills to assess, recognize, and manage dysphagia and to enhance patient safety.
期刊論文
1.Achem, S. R.、DeVault, K. R.(2005)。Dysphagia in aging。Journal of Clinical Gastroenterology,39(5),357-371。  new window
2.Falsetti, P.、Acciai, C.、Palilla, R.、Bosi, M.、Carpinteri, F.、Zingarelli, A.、Lenzi, L.(2009)。Oropharyngeal dysphagia after stroke: Incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit。Journal of Stroke and Cerebrovascular Diseases,18(5),329-335。  new window
3.Finestone, H. M.、Greene-Finestone, L. S.(2003)。Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional management for stroke patients。Canadian Medical Association Journal,169(10),1041-1044。  new window
4.Frey, K. L.、Ramsberger, G.(2011)。Comparison of outcomes before and after implementation of a water protocol for patients with cerebrovascular accident and dysphagia。Journal of Neuroscience Nursing,43(3),165-171。  new window
5.Gleeson, D. C. L.(1999)。Oropharyngeal swallowing and aging: A review。Journal of Communication Disorders,32(6),373-396。  new window
6.Guyomard, V.、Fulcher, R. A.、Redmayne, O.、Metcalf, A. K.、Potter, J. F.、Myint, P. K.(2009)。Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: A database study。Journal of the American Geriatrics Society,57(11),2101-2106。  new window
7.Hughes, S. M.(2011)。Management of dysphagia in stroke patients。Nursing Older People,23(3),21-24。  new window
8.Langdon, P. C.、Lee, A. H.、Binns, C. W.(2007)。Dysphagia in acute ischaemic stroke: Severity, recovery and relationship to stroke subtype。Journal of Clinical Neuroscience,14(7),630-634。  new window
9.Leder, S. B.、Suiter, D. M.、Warner, H. L.、Acton, L. M.、Swainson, B. A.(2012)。Success of recommending oral diets in acute stroke patients based on passing a 90-cc water swallow challenge protocol。Topics in Stroke Rehabilitation,19(1),40-44。  new window
10.Maeshima, S.、Osawa, A.、Takajo, F.、Kurozumi, S.、Ota, N.、Kumakura, I.(2007)。A comparison study of aspiration with clinical manifestions in stroke patients。Brain and Nerve,59(5),521-526。  new window
11.Mann, G.、Hankey, G. J.、Cameron, D.(1999)。Swallowing function after stroke: Prognosis and prognostic factors at 6 months。Stroke,30(4),744-748。  new window
12.小口和代、才藤栄一、水野雅康、馬場尊、奥井美枝、鈴木美保(2000)。機能的嚥下障害スクリーニングテスト「反復唾液嚥下テスト」(the Repetitive Saliva Swallowing Test: RSST)の検討:(1)正常値の検討。リハビリテーション医学,37(6),383-388。  延伸查詢new window
13.Paciaroni, M.、Mazzotta, G.、Corea, F.、Caso, V.、Venti, M.、Milia, P.、Gallai, V.(2004)。Dysphagia following stroke。European Neurology,51(3),162-167。  new window
14.Teasell, R.、Foley, N.、Fisher, J.、Finestone, H.(2002)。The incidence, management, and complications of dysphagia in patients with medullary strokes admitted to a rehabilitation unit。Dysphagia,17(2),115-120。  new window
15.Tohara, H.、Saitoh, E.、Mays, K. A.、Kuhlemeier, K.、Palmer, J. B.(2003)。Three tests for predicting aspiration without videofluorography。Dysphagia,18(2),126-134。  new window
16.Martino, R.、Foley, N.、Bhogal, S.、Diamant, N.、Speechley, M.、Teasell, R.(2005)。Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications。Stroke,36(12),2756-2763。  new window
17.鄭綺、許寶鶯、陳靜敏、陳淑如、曾櫻枝(20010900)。Clinical Validation of the Related Factors and Defining Characteristics of Impaired Swallowing for Patients with Stroke。The Journal of Nursing Research,9(4),105-115。new window  new window
18.Travers, P. L.(1999)。Poststroke Dysphagia: Implications for Nurses。Rehabilitation Nursing,24(2),69-73。  new window
19.DePippo, K. L.、Holas, M. A.、Reding, M. H.(1994)。The Burke Dysphagia Screening Test: Validation of its Use in Patients with Stroke。Archives Physical Medicine & Rehabilitation,75(12),1284-1286。  new window
20.Palmer, J. B.,、Drennan, J. C.、Baba, M.(2000)。Evaluation and treatment of swallowing impairments。American Family Physician,61(8),2453-2462。  new window
圖書
1.Logemann, J. A.(1998)。Evaluation and treatment of swallowing disorders。San Diego, CA:College-Hull。  new window
其他
1.衛生福利部(2013)。民國101 年死因統計年報,http://www.mohw.gov.tw。  延伸查詢new window
2.Scottish Intercollegiate Guidelines Network(2010)。Management of patients with stroke: Identification and management of dysphagia,http://www.sign.ac.uk/guidelines/fulltext/119/index.html。  new window
 
 
 
 
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