長期經口插管對口腔及咽部結構、構音發聲功能之影響

The Effects on Oral and Pharyngeal Structures, Articulation and Phonation Functions following Prolonged Endotracheal Intubation

吳國湘(Kuo-Hsiang Wu)

指導教授 ： 陳佳慧

國立臺灣大學/醫學院/護理學研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.02436

摘要

背景：氣管插管在急重症單位是一常見且重要的技術，其對人體的傷害不僅發生於插管的當下，亦會在管路留置期間逐漸產生。這些傷害除造成病人不適感及結構上的損傷外，也會影響口腔喉部構音發聲的功能。而這些功能不一定會自動回復。
研究目的：欲了解長期經口插管對病人主觀感覺、口腔結構及構音發聲功能的損傷、盛行率及其恢復情形。
研究方法：採前瞻性、縱貫性的研究設計，以連續取樣收案。研究工具包括自訂口腔結構損傷調查表、主觀症狀調查表、構音發聲功能評估表、口腔評估指引(OAG)。針對經口插管滿48小時之病人，於成功拔管後48小時內(T0)、7天(T1)、14天(T2)等時間點進行資料收集。
研究結果：收案人數共計50人，平均插管天數為7.9±5.3天。剛拔管時，分別有54%、54%的病人表示輕微喉嚨疼痛、輕微呼吸困難。口腔內損傷（潰瘍、發紅、水腫等）在軟硬顎、前後柱出現比例最高。口腔潰瘍的盛行率為T0：68.2%、T1：48.6%、T2：28%。聲音改變率T0、T1、T2為100%、92.7%、78.6%；唇及舌的構音能力在T0時最差，T2時也只約一半參與者完全恢復。S/Z ratio的評估結果顯示T0、T1時肺活量及喉部狀況都未恢復，T2時喉部已較恢復，但肺活量仍未恢復。OAG分數在T0、T1、T2分別為16.3±2.4、13.8±3.7、12.4±3.1分；三次分數差異達顯著，p<0.001。
結論：長期插管對病人的口腔狀況、唇及舌的構音能力、聲音性質皆會帶來皆會帶來重大影響，且其恢復需要兩周（甚至以上）的時間。

關鍵字

長期插管 ； 經口插管 ； 損傷 ； 構音發聲

並列摘要

Background: With advances in medical science, an increasing number of patients require airway support and are able to wean from mechanical ventilation. However, orotracheal tube intubation may have temporary, even permanent effects on oral and pharynx structures and functionality of articulation and phonation.
Purpose: To investigate the prevalence of oral and pharynx damage and impairments of articulation and phonation after prolonged endotracheal intubation.
Method: We conducted a prospective, longitudinal study with a consecutive sampling. Participants were recruited consecutively from 6 medical intensive care units at an urban medical center in Taiwan. Participants’ oral and pharynx structures, articulation and phonation functions were assessed at three time points: 48 hours within extubation, and 7th and 14th day post-extubation.
Result: In total, 50 participants were included in this study (33 males and 17 females, age of 60.7±14.9 years, and average length of intubation was 7.9±5.3 days). The prevalence of sore throat was 54%. The prevalence rates of oral ulcers were 68.2%, 48.6%, and 28%, respectively, within 48 hours, 7th and 14th day after extubation. The articulation was significantly affected but about half of the participants recovered within 14 days after extubation. Seven days after extubation, the quality of voice, measured by S/Z ratio, was higher than 1.4 suggesting impairment on phonation. At 14th day after extubation, although S/Z ratio was back to normal, most patients still presented with shorter durations of S and Z sound suggesting pulmonary insufficiency. Overall, the oral conditions after extubation, measured by the oral assessment guide were poor with scores ranged from 16.3±2.4, 13.8±3.7 and 12.4±3.1, respectively (p <0.001).
Conclusion: The impairments on oral and pharynx structures, articulation, and phonation were highly prevalent after prolonged orotracheal intubation and the recovery of these conditions may take 2 weeks, or even longer.

並列關鍵字

prolonged intubation ； orotracheal intubation ； damage ； articulation ； phonation

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