- 期刊
新冠肺炎後的吞嚥障礙：文獻綜述
Swallowing Dysfunction Following the COVID-19 Infection: A Literature Review
摘要
新冠肺炎為2020年由世界衛生組織正式命名的新興傳染性疾病，主要由新型冠狀病毒所引起，大部分症狀諸如咳嗽、發燒等在支持性治療下多能改善。然而少數患者會進展至呼吸窘迫或合併其他神經問題，進而影響吞嚥功能。新冠肺炎相關吞嚥障礙的主要機轉包含神經疾患、肌肉病變及加護病房相關的吞嚥障礙。由於吞嚥困難會降低生活品質及增加呼吸道併發症風險，因此急性感染過後，早期的吞嚥介入是相當重要的，包含藉由床邊測試或問卷所做的臨床評估、透視螢光吞嚥及吞嚥內視鏡等影像檢查。吞嚥復健部分，除了傳統的面對面吞嚥訓練，因疫情逐漸被重視的遠距復健模式使患者得已在隔離時能夠接受吞嚥復健。另一方面，新冠肺炎流行期間，醫師和治療師應有適當的防護以降低感染風險。因此，了解產生氣溶膠的醫療程序的風險及相對應的個人防護裝備是一項重要的課題。本文透過完整的文獻回顧，探討吞嚥障礙在新冠肺炎患者的盛行率、引起吞嚥障礙的機轉、個人防護裝備分級、吞嚥障礙的評估及復健治療等，提供新冠肺炎後吞嚥障礙的最新進展及相關的臨床指引。
並列摘要
Coronavirus disease 2019 (COVID-19), named by the World Health Organization in 2020, is a novel infectious disease, causing by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most symptoms, such as cough and fever, will be resolved following supportive management. However, a small number of patients will progress to respiratory distress or suffer other neurological problems that affect their swallowing function. Potential dysphagia mechanisms associated with COVID-19 include neurological complications, muscular disorder, and intensive care unit-acquired swallowing dysfunctions. As dysphagia results in a declined quality of life and increased risk of respiratory complications, early swallowing interventions are imperative after the acute phase of infection. These interventions include clinical assessments through bedside swallowing examination or questionnaire, imaging studies with videofluoroscopic swallowing study, and fiberoptic endoscopic evaluation of swallowing. In swallowing rehabilitation, aside from the conventional face-to-face treatment, telerehabilitation service in response to the COVID-19 pandemic enables patients in isolated status to receive swallowing rehabilitation. Conversely, during the COVID-19 pandemic, clinicians and therapists should appropriately wear personal protective equipment to reduce the infection risk. Therefore, being aware of the risk of aerosol-generating procedures and understanding relevant levels of personal protective equipment becomes an important subject. In the current literature review, we presented the prevalence of dysphagia following the COVID-19 infection; pertinent etiologies, classifications, and indications of the personal protective equipment; dysphagia evaluation and rehabilitative strategies aiming to provide the clinical guidance of dysphagia, following the COVID-19 infection with recent research advances.