吞嚥治療對不同年齡層腦中風吞嚥困難病人之療效探討

Effect of Swallowing Therapy for Post-stroke Dysphagic Patients of Different Ages

林仲哲(Chung-Che Lin) ； 林羿辰(Yi-Chen Lin) ； 李婕瑜(Chieh-Yu Li) ； 劉睿菁(Jui-Ching Liu) ； 顏向嬋(Hsiang-Chan Yen) ； 張玉君(Yu-Jun Chang)

《台灣老年醫學暨老年學會雜誌》 15卷4期 (2020/11) Pp. 271-282

https://doi.org/10.29461/TGGa.202011_15(4).0003

摘要

目的：探討不同年齡層腦中風吞嚥困難病人拔除鼻胃管與年齡、性別、腦中風類型及位置、吞嚥功能評量分數、吞嚥治療次數、採用的吞嚥治療策略之間的關係。方法：本研究為回溯性研究，我們先將所有個案以有無拔除鼻胃管分組，依不同年齡層以獨立樣本t檢定和單因子變異數分析來做連續變項的比較。然後以配對樣本t檢定比較治療前後功能評量分數改變的情況。並使用卡方檢定做二組之間的比較，以檢驗各臨床類別變項的分佈是否有差異。最後再以單一與多元邏輯迴歸分析，探究可拔除鼻胃管的可能相關因子，並找出適合不同年齡族群的優先吞嚥治療策略。結果：本研究共收錄694個病人，有205人（29.5%）拔除鼻胃管，顯著相關聯因子有年齡較低、治療前的FOIS分數較好、治療策略數目較多、採用安全吞嚥法、改變進食姿勢、及食物的選擇這三種吞嚥治療策略。經勝算比演算分析，年齡小於75歲、治療前的FOIS分數較好、採用安全吞嚥法及改變進食姿勢治療策略，對所有年齡層可拔除鼻胃管的勝算比均顯著較高。結論：吞嚥治療對高齡吞嚥困難病人有正向的益處，改變進食姿勢及安全吞嚥法這兩種治療策略對所有年齡層都建議優先選用。

關鍵字

高齡者 ； 腦中風 ； 吞嚥困難 ； 吞嚥治療

並列摘要

Objectives: This study aimed to explore the relationships between nasogastric tube (NGT) removal in post-stroke dysphagic patients of different ages and their demographic characteristics (such as age, sex, and stroke type, lesion location), functional oral intake scale (FOIS), duration of swallowing therapy, and therapeutic swallowing strategies. Method: Retrospective in nature, the study first classified all cases into 2 groups (with and without NGT removal) for comparison by age with independent samples t-test and one-way ANOVA followed by Bonferroni multiple comparisons adopted to compare continuous variables. Paired t-test was then used to compare the changes of FOIS scores before and after therapy. Additionally, chi-square test was used to compare the 2 groups by examining possible differences in the distribution of each clinically relevant variable. Finally, univariate and multivariate logistic regression analyses were conducted to explore related factors of the NGT removable and to identify the preferred swallowing strategies for patients in different age groups. Result: Of the 694 recruited patients, 205 (29.5%) patients had their NGT removed. Significant factors related to NGT removal included younger age, better FOIS, and a greater number of swallowing strategies adopted (primarily supraglottic maneuver, posture adjustment and diet modification). Related factors of significantly higher examined odds ratio of NTG removal included age younger than 75 years, better FOIS, and use of supraglottic maneuver and posture adjustment. Conclusion: Swallowing therapy shows positive effects for elderly patients with dysphagia. Posture adjustment and supraglottic maneuver appear to be the preferred swallowing strategies for patients in all age groups.

並列關鍵字

elderly ； stroke ； dysphagia ； swallowing therapy