謝克氏運動對腦中風病人在吞嚥困難之成效：系統性回顧暨統合分析

背景：吞嚥困難是腦中風病人常見合併症之一，儘早給予吞嚥訓練，可降低併發症發生，提升其生活品質。諸多研究顯示以謝克氏運動治療有助於改善腦中風病人之吞嚥困難，但對腦中風病人之成效不一，須進一步檢視其有效證據及實質成效。目的：本研究以系統性回顧暨統合分析法，分析謝克氏運動對腦中風併吞嚥困難病人之成效。方法：總共搜尋8種電子資料庫包括：華藝線上圖書館、臺灣碩博士論文知識加值系統、PubMed、Embase、MEDLINE、The Cochrane Library、CINAHL Plus with Full Text、Web of Science（WOS）。將符合納入準則之文獻，使用Cochrane偏誤風險評估工具評讀研究品質，並以Review Manager 5.3統計軟體進行統合分析。結果：結果顯示謝克氏運動對於改善腦中風吞嚥困難病人食物滲入－吸入呼吸道之成效具顯著效益值，綜合效果量為-1.13（95% CI =〔-1.55,-0.70〕），且同時能夠提升由口進食程度、增加鼻胃管移除率、緩解病人憂鬱及改善舌骨垂直位移程度。結論與建議：謝克氏運動方可改善吞嚥障礙的功能，臨床應用建議每天執行三次抬頭等長收縮運動，每次停置60秒後，再休息一分鐘；30次的抬頭等速收縮運動，持續4週以上。建議未來研究針對腦中風吞嚥困難病程探討謝克氏運動之效益並建立謝克氏運動照護指引。

關鍵字

腦中風；吞嚥困難；謝克氏運動

並列摘要

Background: Dysphagia is one of the common comorbidities of stroke patients. Offering swallowing training as early as possible can reduce complications and improve their quality of life. Many studies have shown that the use of Shaker exercise can help to improve dysphagia in stroke patients, but the effectiveness of Shaker exercise on stroke patients with dysphagia is controversial, and it is necessary to further review its effective evidence and substantial results. Purpose: This study used systematic review and meta-analysis to explore the effects of Shaker exercise on dysphagia of patients with stroke. Methods: A total of 8 electronic databases were searched including the Airiti Library, National Digital Library of Theses and Dissertations in Taiwan, PubMed, Embase, MEDLINE, The Cochrane Library, CINAHL Plus with Full Text, and Web of Science (WOS). For studies meeting the inclusion criteria, the Cochrane collaboration's tool was applied for assessing risk of bias in order to evaluate the quality of research, while data from these included studies were then analyzed using Review Manager 5.3 statistical software for meta-analysis. Results: After the intervention of Shaker exercise, the effect of food penetration-aspiration airway on stroke patients with dysphagia was significantly different, and the effect size was -1.13(95% confidence interval between -1.55 and -0.70). In the meantime, Shaker exercise could also improve the degree of food intake from the mouth, increase the removal rate of nasogastric tube, relieve the depression of patients, and improve the vertical displacement of the hyoid bone. Conclusions and recommendations: Shaker exercise can improve the function of dysphagia. Clinical application is recommended to perform head-up isometric contraction three times a day, rest for another minute after stopping for 60 seconds each time, then finally 30 times head-up isokinetic contraction exercises can be performed, with the sequence continuing more than 4 weeks. It is suggested that future research should explore the benefits of Shaker exercise and establish guidelines of Shaker exercise for the course of stroke with dysphagia.

並列關鍵字

Stroke ； dysphagia ； Shaker exercise

參考文獻

司麗雲、謝素英、曾素美、黃慈心(2017)．住院復健期腦中風患者吞嚥困難之決定因子探討．護理雜誌，64(3)．43-55。https://doi.org/10.6224/JN.000039

林豐裕、沈煥庭、廖靜珠、詹琪文(2013)．實證的統合分析．長期照護雜誌，17(2)．81-88。https://doi.org/10.6317/LTC.201308_17(2).0002

莊其穆(2011)．臨床醫師如何閱讀統合分析(Meta-analysis)的論文．臺灣醫界，54(2)．74-82。https://doi.org/10.30044/TMJ.201102.0003

黃如萍、葉美玲(2013)．氣功對第二型糖尿病患之血糖控制成效-系統性回顧暨統合分析．護理暨健康照護研究，9(3)．199-209。https://doi.org/10.6225/JNHR.09.3.199

黃婷、張瑛瑛、廖若伶、黃春佈、廖月鳳、施美伶(2018)．提升腦中風病人執行吞嚥訓練自我練習完整率．榮總護理，35(3)．314-321。https://doi.org/10.6142/VGHN.201809_35(3).0010

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謝克氏運動對腦中風病人在吞嚥困難之成效：系統性回顧暨統合分析

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