吞嚥困難病人接受吞嚥攝影成效之探討

The Impact of Videofluroscopy Swallowing Study on Medical Resource Utilization and Medical Outcomes among Deglutition Disordered Patients

洪國瑋(Kuo-wei Hung)

指導教授 ： 許弘毅

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2018年)

摘要

吞嚥困難可能影響許多疾病的治療，包括癌症、退化性疾病、腦中風與肺炎，也常造成病人營養失衡。在開始執行吞嚥螢光攝影評估任何有吞嚥困難表徵者時發現竟然有高於70%為吞嚥功能障礙。因而我們開始深入研究施行吞嚥螢光攝影是否在臨床上以及醫療資源耗用上有所幫助。我們針對腦中風的病人做病例回朔性研究發現有施行吞嚥螢光攝影的病人族群有相對較低的再住院率、較短的住院天數、以及較少的資源耗用相對於未施作攝影的病人。於進一步分析其中有住院治療的族群發現有施行吞嚥螢光攝影者存活率與肺部復原情形都比未施作者好。

關鍵字

吞嚥困難 ； 吞嚥螢光攝影

並列摘要

Deglutition disorder has been studied and found to influence the treatment of many degenerative diseases and serious medical problems such as stroke, pneumonia, and cancer. It is also a major cause of malnutrition which is recognized to be related to prolonging disease recovery, increasing in-hospital length of stay, and increased morbidity and mortality. We started enrolling patients with signs and symptoms of swallowing difficulties and arranged videofluroscopy swallowing study (VFSS) to evaluate the severity. Initially we found these patients having high incidence of silent aspiration (>70%) and most of them were clinically unveiled and untreated. We have adjusted treatments for these patients according to the finding of VFSS and successfully helped patients regained the ability of oral feeding. We further investigate how VFSS had helped on treating cerebrovascular accident (CVA) patients and collected 219 patients with VFSS done and randomly selected 219 CVA cases not having VFSS done with the similar age distribution to compare between groups how medical resource are used within 180 days. We found that CVA patients with VFSS done to guide their treatments and food texture adjustment had less admission frequency, shorter in-hospital stay, and significantly fewer medical expenses within 180 days. We concluded by having VFSS arranged for CVA patients can help in medical resource utilization and better outcome by reducing in-hospital length and re-admissions. To clarify how hospitalization influenced on medical resource usage, we found patients with VFSS done have better survival rate and more improvement of lung condition.

並列關鍵字

deglutition disorder ； videofluroscopy swallowing study

參考文獻

何怡慧, 劉秀月, and 黃純德. 2014. '復建期腦中風病患咀嚼吞嚥障礙盛行率及初步篩檢徵象之探討', 護理雜誌, 61: 54-62.

李怡珍, 顏欽堉, 林玫吟, 于錫倩, and 張敏德. 2014. '探討口腔癌術後早期介入吞嚥訓練及監測進食安全之成效及影響因素', 臺灣口腔顎面外科學會雜誌, 25: 1-7.

施至遠. 2008. '老年人吞嚥障礙之評估與處置', 長期照護雜誌, 12: 337 - 45.

Acikel, B., and M. Ak. 2018. 'Functional Cause of Dysphagia Improved with Cognitive Behavioural Treatment', Dysphagia, 33: 266-67.

Cichero, J. A., P. Lam, C. M. Steele, B. Hanson, J. Chen, R. O. Dantas, J. Duivestein, J. Kayashita, C. Lecko, J. Murray, M. Pillay, L. Riquelme, and S. Stanschus. 2017. 'Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework', Dysphagia, 32: 293-314.