吞嚥困難照護小組介入居家個案移除鼻胃管之成效

The Effectiveness of Intervention for Removing Nasogastric Tube in Home Cases by Dysphagia Team

鄭鈺郿(Yu-Mei Jeng) ； 呂美卿(Mei-Ching Leu) ； 黃詩珊(Shih- Shan Huang) ； 余筱甜(Hsiao-Tien Yu) ； 葉亭彣(Ting-Wen Yeh) ； 朱怡蓁(I-Chen, Chu)

《北市醫學雜誌》 預刊文章 Pp. 1-12

https://doi.org/10.6200/TCMJ.202101/PP.0018

摘要

衛生福利部國民健康署統計在65歲以上老年人口，有12.8%約逾40萬人有吞嚥困難的狀況，臨床處置上多以鼻胃管灌食取代由口進食。本文旨在探討以吞嚥困難小組（以下簡稱吞嚥小組）介入居家照護鼻胃管移除之成效。以2018年9月至2019年12月期間，以13位已接受鼻胃管餵食且有意願移除或吞嚥障礙者作為收案個案，分別以進食狀態、意識狀況、EAT-10分數、吞水測試進行評估，結果顯示完全管灌飲食者佔61.5%，吞水測試則常常嗆住難以全部喝完佔53.8%，EAT-10評分，超過3分以上項目以「我的吞嚥問題，影響我的外出用餐」最高佔84.6%。經吞嚥小組介入進行吞嚥照護，成功地移除5位鼻胃管，移除率達38.4%，後續評估顯示：吞水測試可一口喝完無噎嗆佔80%，100%個案進食狀態改為經口進食佔，且未發生移除後肺炎現象，EAT-10評分「我的吞嚥問題，影響我的外出用餐」下降至40.0%。本專案以早期評估、早期團隊介入為出發點，透過轉介收案前的詳細溝通及說明照護計畫，取得個案及家屬的認同與共同合作移除管路，讓個案享受進食樂趣，更能提昇服務品質，實為團隊合作成效之最佳證明。

關鍵字

吞嚥障礙 ； 鼻胃管 ； EAT-10

並列摘要

According to the Ministry of Health and Welfare statistics, 12.8% of the population (more than 400,000 people) over 65 years old had dysphagia. Clinically, nasogastric tube feeding is used to substitute oral feeding. This article aims to explore the effectiveness of nasogastric tube removal in home cases by the dysphagia team. From September 2018 to December 2019, the patients who had been fed with the nasogastric tube and were willing to be removed were referred for evaluation on feeding status, consciousness status, EAT-10 score, and water swallowing test. The results showed 61.5% of the cases used complete tube feeding for eating and drinking, 53.8% of the cases often choked and could not ingest all water in the water swallow test, and 84.8% of those who had ≥3 in EAT-10 had 〞my swallowing problem affects my eating out.〞 On enrolling the cases for swallowing care, five cases successfully removed the nasogastric tubes (38.4%). Follow-up evaluation revealed: 80% without choking after one gulp in water swallow test, 100% with oral feeding, and the frequency of pneumonia was 0, 〞My swallowing problem affects my dining out〞 in EAT-10 dropped to 40.0%. Based on the concept of early evaluation and early team intervention, and through clear communication and explanation of the care plan before the referral, the project gained recognition from the cases and their family members and their collaborations to remove the tubes earlier. As a result, the cases can then enjoy eating; the quality of service is improved, which is the best proof of team effectiveness.

並列關鍵字

swallowing disorders ； nasogastric tube ； EAT-10