增進體能，減少鼻胃管置入－無管人生

Improve Physical Fitness and Reduce Nasogastric Tube Insertions: Working to Achieve a 'No Tube' Life

王俊傑(Chun-Chieh WANG) ； 胡月娟(Yueh-Juen HWU) ； 黃建華(Chien-Hua HUANG)

《護理雜誌》 69卷1期 (2022/02) Pp. 6-11

https://doi.org/10.6224/JN.202202_69(1).02

摘要

臨床上常見病人因吞嚥困難導致進食量少，營養不良、或是因為經常嗆咳導致吸入性肺炎。放置鼻胃管灌食的目的是作為營養與水分補充的途徑以及預防由口進食造成嗆入。已知明確原因的吞嚥困難可藉由內外科的治療改善，但是對於退化性疾病而言，則須仰賴營養支持與復健治療，增強肌肉力量與協調性，減少日後放置鼻胃管的機率。一般針對吞嚥困難的肌力訓練會聚焦在吞嚥、呼吸相關的肌肉，但是若觀察人體正常的進食動作，需下肢肌群與軀幹肌群的協調運作，以支撐人體的重量並維持姿勢穩定，接著拿取食物時則須仰賴上肢肌群的活動，所以，若可以實施相關肌肉群的訓練，亦可減少因肌力的減退造成的進食困難。本文收集改善衰弱之相關實證文獻證據，並提供增進體能方案之原則及實務操作建議，包括呼吸肌強化訓練、坐姿及平衡能力訓練、上肢肌力訓練及下肢肌力訓練，希望做為臨床實務之參考。

關鍵字

吞嚥困難 ； 肌力訓練 ； 增進體能方案

並列摘要

It is common in clinical settings for patients to suffer from dysphagia-related malnutrition and coughing-related aspiration pneumonia because of reduced levels of food intake. Nasogastric tube feeding provides nutrition and water and prevents choking related to oral feeding. Although dysphagia is often treated using medical and surgical treatments, degenerative-disease-related dysphagia is currently widely treated using nutritional support and rehabilitation to enhance muscle strength and coordination and reduce the risk of nasogastric tube placement in the future. Generally, the focus of muscle strength training for dysphagia is on muscle training related to swallowing and breathing. However, the process of eating requires the coordinated operation of the muscles of the lower limbs and the trunk to support the body's physical weight and maintain stable posture. When consuming food, an individual must rely on the activities of the upper limb muscles. Therefore, training the relevant muscles may effectively reduce the eating difficulties caused by muscle strength loss. In this article, empirical literature evidence related to improving frailty is collected and principles and practical suggestions are provided for improving physical fitness programs, including breathing muscle strengthening training, sitting and balance training, upper limb muscle strength training, and lower limb muscle strength training. It is hoped that the findings will be used as a guide in clinical practice.

並列關鍵字

dysphagia ； muscle strength training ； physical fitness program

參考文獻

黃純德（2020）．咀嚼吞嚥障礙、吸入性肺炎與口腔衛生不良的三角關係．護理雜誌，67（4），14–23。[Huang, S.-T. (2020). The triangular relationship among swallowing disorders, aspiration pneumonia, and poor oral hygiene. The Journal of Nursing, 67(4), 14–23.]

Abdel Jalil, A. A., Katzka, D. A., & Castell, D. O. (2015). Approach to the patient with dysphagia. The American Journal of Medicine, 128(10), 1138.e17–1138.e23.

Apóstolo, J., Cooke, R., Bobrowicz-Campos, E., Santana, S., Marcucci, M., Cano, A., Vollenbroek-Hutten, M., Germini, F., D’Avanzo, B., Gwyther, H., & Holland, C. (2018). Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 16(1), 140–232.

Balou, M., Herzberg, E. G., Kamelhar, D., & Molfenter, S. M. (2019). An intensive swallowing exercise protocol for improving swallowing physiology in older adults with radiographically confirmed dysphagia. Clinical Interventions in Aging, 14, 283–288.

Bambrick, P., Phelan, N., Grant, E., Byrne, T., Harrison, M., Mulcahy, R., & Cooke, J. (2021). Diet and exercise for FRAILty (DEFRAIL): Protocol for a study to examine the effect of a novel community-based group exercise and nutritional intervention, designed to reverse frailty in older adults. BMJ Open, 11(6), Article e042408.