Evaluation of Pediatric Subjects with Swallowing Disorder Part II

小兒吞嚥障礙之評估－第二部分

Luh Karunia Wahyuni ； 蕭名彥(Ming-Yen Hsiao) ； 王興國(Hsing-Kuo Wang) ； 王亭貴(Tyng-Guey Wang)

《台灣復健醫學雜誌》 41卷3期 (2013/09) Pp. 163-171

https://doi.org/10.6315/2013.41(3)02

摘要

在第一部分中主要介紹小兒吞嚥的特點、小兒與成人口咽構造上的差異以及小兒常見疾病的吞嚥問題；這個部分主要探討小兒吞嚥功能的評估。對於小兒族群吞嚥功能的評估需要團隊的合作、跨領域的結合以及不同儀器的檢查，才能建立正確的診斷並安排適當的治療計畫，在臨床上是極富挑戰性的任務。本文介紹臨床上小兒吞嚥評估的重要病史及理學檢查；並且探討目前應用在小兒吞嚥評估上不同的儀器檢查：包含了錄影螢光吞嚥檢查（videofluoroscopic swallowing study）、光纖內視鏡吞嚥檢查（fiberoptic endoscopic evaluation of swallowing）、血氧偵測儀（oximetry）以及超音波（ultrasonography）這些檢查的臨床應用、優點以及使用上的限制。對於超音波在小兒吞嚥評估上的應用、檢查技術以及相關解剖構造在超音波影像的呈現亦有詳細的敘述。超音波由於方便攜帶、無侵入性以及不具放射線，非常適合用在小兒族群的檢查。雖然仍需更多研究證據佐證，目前初步的文獻指出超音波可以用於觀察吞嚥的過程、為小兒族群吞嚥功能的評估提供額外的資訊。

關鍵字

吞嚥障礙（deglutition disorders） ； 小兒（pediatrics） ； 超音波（ultrasonography）

並列摘要

The characteristics of pediatric swallowing, anatomical differences between pediatrics and adults, and swallowing problems in common pediatric diseases had been introduced in Part 1 of the article. The common methods for evaluation of pediatric swallowing are discussed in this part. The evaluation of swallowing function in pediatric patients is a great clinical challenge. It requires a team approach, an integration of multiple disciplines, and instrumental evaluations for establishing a diagnosis and developing an appropriate management plan. This article provides an introduction of the vital concept of clinical bedside evaluation and instrumental evaluation including the videofluoroscopic swallow study (VFSS), fibroptic endoscopic evaluations of swallowing (FEES), oximetry, and ultrasonography. The clinical applications, advantages, and limitations of these techniques are discussed. The imaging techniques and related anatomy of ultrasonographic evaluation of swallowing have been described in detail. Ultrasonography is an ideal tool for observing the soft tissues including the tongue and mouth floor muscles, and it has been implemented in assessing the suckling movements of infants. More research is needed to define the role of ultrasonography in evaluating the swallowing function in pediatric patients.