運用下巴下壓技巧改善腦中風病人吞嚥困難之成效探討

Effectiveness of Chin-down Maneuver to Improve Dysphagia in Stroke Patients

戴秀好(Shiu-Hao Tai) ； 梁穎(Ying Liang) ； 蕭世美(Shih-Mei Hsiao) ； 蔡容容(Jung-Jung Tsai) ； 許秀娟(Hsiu-Chuan Hsu) ； 邱然偉(Jan-Wei Chiu)

《北市醫學雜誌》 15卷2期 (2018/06) Pp. 70-80

https://doi.org/10.6200/TCMJ.201806_15(2).0008

摘要

目的：下巴下壓(Chin-down)吞嚥技巧對吞嚥困難病人，能有效保護氣道，減少進食過程中食物誤入氣道之危險，進而預防吸入性肺炎。瞭解腦中風併吞嚥困難病人運用下巴下壓(Chin-down)吞嚥技巧之改善成效。方法：研究方法採類實驗性研究設計，選取某醫學中心神經內科及復健科病房之腦中風併吞嚥困難之住院病人，共收案60位，以抽籤方式分為兩組，實驗組及控制組各30位。實驗組每天進食至少執行3次下巴下壓(Chin-down)吞嚥動作，每次3-5分鐘，為期4週；指標為「吞嚥問卷」、「吞嚥自我評估量表(EAT-10)」、「嗆咳頻率」、「鼻胃管移除率」、「吸入性肺炎發生率」。結果：研究顯示在經由4週下巴下壓(Chin-down)吞嚥技巧訓練後，實驗組在吞嚥問卷積分及吞嚥自我評估量表(EAT-10)積分，與控制組達顯著差異(p ＜.05)，嗆咳頻率兩組達顯著差異(p ＜.05)，在鼻胃管移除率、吸入性肺炎發生率兩組無顯著差異。結論：腦中風併吞嚥困難之住院病人運用下巴下壓(Chindown)吞嚥技巧有助於改善病人吞嚥問題，養成正確的進食習性，降低嗆咳率，提升臨床照護品質。

關鍵字

下巴下壓 ； 腦中風 ； 吞嚥困難

並列摘要

Objective: Chin-down swallowing posture has been demonstrated as a safe adjuvant technique that prevent tracheal aspiration and silent aspiration pneumonia in patients with dysphagia. We aimed to investigate the effects of Chin-down swallowing technique in stroke patients with dysphagia. Methods: A total of 60 patients with stroke and dysphagia were recruited by convenience sampling method from the rehabilitation department and the neurologic department of a medical center. The patients were allocated to experimental group and control group by using drawing method, each with 30 patients. Chin-down swallowing technique was applied in patients of the experimental group at least 3 times a day and 3-5 minutes at each time for a 4-week period. Surveys using the swallowing questionnaire and the swallow Self-Assessment (EAT- 10) were completed at beginning and after 4 week training, so as the recording of choking and coughing frequency, nasogastric tube (NGT) removal rate, and the occurring rate of aspiration pneumonia. Results: Significant differences were observed in the score of swallowing questionnaire and EAT-10, and the choking and coughing frequency between the experimental group and the control group (p ＜.05) after intervention. There was no significant differences in NGT removal rate and occurring rate of aspiration pneumonia between groups. Conclusion: Chin-down swallowing technique ameliorates the difficulties in swallowing and forming correct ingesting habits, and lowers the choking and coughing frequency and thus promotes the quality of care in stroke patients with dysphagia.

並列關鍵字

Chin-down posture ； Stroke patients ； Dysphagia