吞嚥困難併營養不良個案之營養改善及經口攝食重建

Improving Oral Intake and Nutritional Management of Dysphagia and Malutrition in a Long-Term Care Patient

張瑄筠(Hsuan-Yun Chang) ； 趙珊(Shan Chao) ； 杜秀容(Hsiu-Jung Tu)

《臺灣膳食營養學雜誌》 8卷2期 (2016/12) Pp. 13-21

https://doi.org/10.6709/TJD.2016.0802.02

摘要

72歲的女性，有糖尿病及高血壓病史。民國97年10月因腦中風住院治療，家人擔心進食攝取量不足，經與醫師討論後以鼻胃管灌食。出院後入住桃園某家養護機構照護，過去飲食史為機構提供管灌食5餐，推估熱量1000-1250 kcal。102年5月入住臺北市立聯合醫院仁愛院區護理之家，入住時身高147.4 cm、體重35.2 kg，身體質量指數（body mass index, BMI）為16.2 kg/m^2。住民意識清楚能簡單回應，家屬期望個案能恢復經口進食。營養師評估其一日熱量需求為1400-1500 kcal，蛋白質需求50 g。入住時由營養師訪視，其營養診斷（problem, P）為體重過輕、病因（etiology, E）為熱量攝取不適當，病徵（symptom, S）為BMI小於18.5 kg/m^2。營養師開立營養處方並建議病人至復健科門診進行吞嚥評估及訓練，改善吞嚥功能。飲食建議採用管灌搭配泥狀、半流、細軟等漸進式飲食，使住民嘗試經口進食。而103年4月體重已經較入住時增加6.2 kg（BMI為19.1 kg/M^2），已達到正常體位範圍內。此個案藉由營養介入後，進行醫療團隊的溝通共同照護，達到攝食適當的營養及水分，得以增進其營養狀況與基本生理功能。

關鍵字

護理之家 ； 吞嚥困難 ； 營養診斷

並列摘要

A 72-year-old woman with a history of diabetes and hypertension was hospitalized for a stroke event on October 2008. Her family members were fear of inadequate food intake of the patient and nasogastric tube feeding was introduced after discussing with the physician. On discharge, she was admitted to a nursing home in Taoyuan, and was given 5 meals a day with an estimated total 1250 kcal intake. Later, she was admitted to our nursing home on May 2013, with an admission height of 147.4 cm, body weight of 35.2 kg, and body mass index (BMI) of 16.2 kg/m^2. She could answer simple questions and her family members expected her to eat by mouth. A dietary assessment indicated a daily energy requirement of 1,400-1,500 kcal and protein requirement of 50 g. Her admission nutrition diagnosis (problem, P) indicated a status of underweight with an etiology (etiology, E) of inadequate energy intake and signs and symptoms (symptom, S) of BMI less than 18.5 kg/m^2. The dietitian advised her to go to the rehabilitation department for assessment and swallowing function training, and recommended tube feeding diet in parallel with progressive oral intake of puree, semi-liquid, soft and ground diet. Her weight then increased by 6.2 kg (BMI 19.1 kg/m^2) and reached the normal range. We concluded that nutritional intervention, multidisciplinary communications and care improved the nutritional status and basic physiological functions of the patient.

並列關鍵字

nursing home ； dysphagia ； nutrition diagnosis