胃造廔管於台灣中風後合併吞嚥障礙病人之使用狀況：部分醫療人員觀點調查

A Focal Survey of Medical Professionals' Conceptions of Gastrostomy in Patients with Dysphagia After Stroke in Taiwan

程聖浩(Sheng-Hao Cheng) ； 陳怡靜(Yi-Ching Chen) ； 蕭名彥(Ming-Yen Hsiao) ； 王亭貴(Tyng-Guey Wang)

《台灣復健醫學雜誌》 47卷2期 (2019/12) Pp. 87-98

https://doi.org/10.6315/TJPMR.201912_47(2).0002

摘要

研究背景及目的：吞嚥障礙（dysphagia）之患者部分需要長期倚賴管灌飲食維持營養狀態，而中風為造成吞嚥障礙之重要原因。然於台灣鼻胃管（nasogastric tube）之使用遠較胃造廔管（gastrostomy tube）普遍。而醫療人員對於使用胃造廔管的時機和認知可能影響患者決策。本研究希冀了解需處理吞嚥障礙病人的醫療專業人員，其對於使用胃造廔管的時機和認知是否和現今國際治療準則一致。方法：此研究採google網路問卷分析不同醫療專業人員對於腦中風患者使用胃造廔管的認知，再加以分析其對病人吞嚥障礙處理的方式和態度。藉由問卷得到的結果和現今的治療準則相比較，並進一步分析是否有差異存在。結果：本研究於2018年5月起至2018年7月止共收集500份問卷，81.8%的專業人員曾推薦病人接受胃造廔管。會建議胃造廔管的考量最主要為病人有可能永久無法脫離鼻胃管（80.9%的人當作其為最主要的原因）。至於中風後放置胃造廔管之時點，26.8%的專業人員認為最適合接受胃造廔管的時機為中風後三個月，25.3%的人認為中風後六個月，20.1%的人認為中風後一年，16.7%的人認為中風後一個月，2.3%的人認為中風後兩週，1.0%的人認為中風後一週。結論：就本研究結果觀之，台灣常處理或接觸吞嚥障礙之專業醫療人員，對於中風放置胃造廔管之概念是合宜的，但對於進行的時間，相對於國外準則則明顯有差異。

關鍵字

胃造廔（gastrostomy） ； 吞嚥障礙（dysphagia） ； 中風（stroke）

並列摘要

Background and aims: People with dysphagia may require long-term tube feeding to maintain adequate nutrition. In Taiwan, nasogastric (NG) tubes are more commonly used than gastrostomy tubes. This practice is inconsistent with international treatment guidelines. Medical professionals' attitudes toward treatment may influence patients' decisions. Therefore, we designed a questionnaire to assess whether medical professionals' conceptions of gastrostomy are consistent with current international treatment principles. Methods: We used an online questionnaire hosted on ＂Google Forms＂ to collect medical professionals' conceptions of gastrostomy. Societies related to dysphagia distributed copies of the questionnaire to their members. The professionals included specialists (physiatrists, otolaryngologists, oral surgeons, nonoral surgery dentists, neurologists, oncologists, pediatricians, gastroenterologists, gastrointestinal surgeons, other physicians, and other surgeons), dietitians, speech therapists, and nurses. The questionnaire responses were compared with current treatment guidelines to identify where major differences existed. Results: Between May and July 2018, we collected a total of 500 questionnaire responses. Among the respondents, 81.8% had recommended gastrostomy to patients. The most commonly reported primary reason for recommending gastrostomy was that the NG tube may never be removed (80.9% of the professionals reported this as a primary reason). Of the surveyed professionals, 26.8%, 25.3%, 20.1%, 16.7%, 2.3%, and 1.0% believed that the most suitable time at which patients with stroke should receive gastrostomy was 3 months, 6 months, 1 year, 1 month, 2 weeks, and 1 week after stroke onset, respectively. Conclusions: The results of this study revealed that the surveyed professionals exhibited appropriate conceptions regarding gastrostomy tube placement but significantly different attitudes with respect to the timing of gastrostomy tube placement in patients with dysphagia after stroke.

並列關鍵字

gastrostomy ； dysphagia ； stroke

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