初探低頭轉頭姿勢影響吞嚥whiteout時間、殘留量、和殘留位置

臨床語言治療師常於病房床邊和治療室，或長照執行吞嚥困難病患的姿勢代償動作，由於探究姿勢代償的量化數據少，因此，本研究以回溯觀察內視鏡影像中，姿勢代償影響吞嚥 whiteout 時間、殘留量與殘留位置。回溯某區域教學醫院 2021 年 1 月至 2022 年 2 月病歷資料，須符合以下條件:a. 年滿 20 歲以上。b. 病患主訴吞嚥困難。c. 各科門住診之病患經醫師醫囑診斷為吞嚥困難(dysphagia)。c.簡易智能量表 (mini-mental status examination, MMSE) 分數大於等於 17 分以上。d.吞嚥功能評估量表 (mann assessment of swallowing ability, MASA) 吞嚥困難總分數大於等於 168 分以上。e.曾接受纖維內視鏡吞嚥檢查的病患資料。f. 檢查過程執行三種姿勢代償。分析比較三種吞嚥姿勢調整椅姿勢代償(吞嚥姿勢代償詳見附錄 5)，包括:第一姿勢為頭部與身體正中姿勢 (矢狀面頭部身體與地板呈垂直)、第二姿勢為低頭 45 度轉頭 60 度(矢狀面低頭屈曲和橫狀面頭部旋轉)和第三姿勢為低頭 45 度轉頭 90 度(矢狀面低頭屈曲和橫狀面頭部旋轉)，影響吞嚥 whiteout 時間、咽喉部殘留量與殘留位置。結果討論:三種姿勢代償對吞嚥 whiteout 時間短但無顯著相關。姿勢代償姿勢三低頭 45 度轉頭 90 度的會厭谿或梨狀竇殘留量和殘留位置少。進一步分析，三種姿勢代償腦中風和非腦中風對吞嚥 whiteout 亦無顯著相關，腦中風對咽喉部殘留量和殘留位置有顯著相關。討論:三種姿勢代償中，隨著姿勢代償的轉頭低頭角度越大，食團殘留於會厭谿或梨狀竇殘留量和位置數也隨著越少。研究限制上有樣本和觀察吞嚥階段、疾病種類。臨床實務上，能幫助語言治療師執行姿勢代償訂定姿勢三低頭 45 度轉頭 90 度目標，能減少食團在會厭谿、梨狀竇殘留量和位置。

關鍵字

吞嚥；姿勢代償；吞嚥 whiteout 時間；殘留量；殘留位置

並列摘要

Clinical speech therapists often perform postural compensation actions for patients with dysphagia at the bedside of the ward, in the treatment room, or under long-term care. Due to the lack of quantitative data on postural compensation, this study retrospectively observed postural compensation in endoscopic images. Affect swallowing whiteout time, residual amount and residual position. To review the medical records of a regional teaching hospital from January 2021 to February 2022, the following conditions must be met: a. Be over 20 years old. b. Patient complains of dysphagia. c. Patients in outpatient clinics of various departments are diagnosed with dysphagia by doctor's order. c. MMSE score is greater than or equal to 17 points or more. d. The total score of MASA dysphagia is greater than or equal to 168 points. e. Data of patients who have undergone fiberoptic endoscopic swallowing examination. f. The inspection process performs three postural compensations. Analysis and comparison of three swallowing postures to adjust the chair posture compensation, including: the first posture is the middle position between the head and the body, the second posture is to lower the head at 45 degrees and turn the head to 60 degrees, and the third posture is to lower the head at 45 degrees and turn the head to 90 degrees, which affects swallowing whiteout Time, throat residual amount and residual location. Discussion of the results: The three postural compensations have no significant correlation with short swallowing whiteout time. Posture compensatory posture three bows the head 45 degrees and turns the head 90 degrees, with less residual amount and residual position of epiglottis or pyriform sinus. Further analysis, the compensatory stroke and non-stroke in the three postures have no significant correlation with swallowing whiteout, and the stroke has a significant correlation with the throat residual volume and residual position. Discussion: Among the three postural compensations, the greater the head-turning and lowering angle of postural compensation, the less the amount and number of food bolus residues in the epiglottis creek or piriform sinus. The study limitations are sample and observation stage of swallowing, type of disease. In clinical practice, it can help speech therapists perform posture compensation and set the goal of three-bow head 45 degrees and turn head 90 degrees, which can reduce the residual amount and position of food boluses in the epiglottis creek and pyriform sinus.