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

Early Interventions of Swallow Training and Outcomes for Oral Cancer Surgery Patients

李怡珍(Yi-Chen Lee) ； 顏欽堉(Ching-Yu Yen) ； 林玫吟(Mei-Yin Lin) ； 于錫倩(His-Chien Yu) ； 張敏德(Min-Te Chang)

《臺灣口腔顎面外科學會雜誌》 25卷1期 (2014/03) Pp. 1-7

摘要

背景：口腔癌發生率目前是台灣男性十大癌症之第四名且有逐年上升之趨勢。治療方式以手術為主，術後易造成組織缺損及疤痕組織進而影響吞嚥功能。本研究目的探討以積極護理介入吞嚥功能復健之評估分析，同時監測進食安全並建立病人進食安全檢查表，最後分析影響口腔癌手術後病人吞嚥功能恢復的因素。對象與方法：使用前瞻性研究法，以立意取樣南部某醫學中心之口腔癌病例，所有病例皆接受手術治療，手術後施行積極性吞嚥訓練照護，使用進食安全查檢表監測病人術後吞嚥功能恢復過程，最後統計分析影響吞嚥功能恢復時間之因素，本研究亦測試由管灌飲食轉換至由口進食的相關指標之信賴度。結果：共87位病人進入此研究，經由積極護理介入復健讓移除鼻胃管之平均時間縮短為8.62天，且所有通過本研究設計之進食安全檢查後移除鼻胃管者，轉換至由口進食之個案均無發生嗆食現象。影響口腔癌術後病人吞嚥功能恢復因素，則與病人之腫瘤大小分期（T）及手術有無合併顎骨切除相關，統計呈現明顯差異。另外有無進行頸部淋巴廓清術亦會影響吞嚥功能的恢復。結論：積極護理介入對口腔癌手術後之病人之吞嚥功能恢復極有幫助，且本研究使用之檢查表可有效作為管灌飲食轉換至經口進食之可靠評估工具。

關鍵字

口腔癌 ； 術後吞嚥訓練 ； 進食安全評核

並列摘要

Background: Oral cancer incidence is the fourth in Taiwan male population, and increases by years. Surgery is the primary choice of the oral cancer treatment. However surgery will damage organ and the scar tissue also affects swallowing function. Our research try to apply intensive nursing care in oral cancer postoperative patients, develop a chart to survey the safety of swallowing training procedure. Finally define the factors that influence of swallowing function recovery. Material and method: prospective clinical study, 87 of oral cancer patients from southern Taiwan was recruited from Jan to Dec, 2009. Intensive nursing care procedure for swallow training launch from the next day after surgery. Check whenever the patients finished training procedure, prepare oral dieting. All the factors influence the recovery of swallowing function would be collecting and analysis. Result: the factors significant related to swallowing function recovery are the tumor stage (T) and the jaw bone involvement in oral cancer surgery. Neck dissection is high related to swallowing function regain (p=0.05). Moreover the check list of feeding safety, is available and reliable, All patient would not chock if they pass the check list after change from nasogastric tube feeding to oral dieting.

並列關鍵字

oral cancer ； swallow training ； oral cancer surgery ； check list of feeding safety