腦中風後吞嚥障礙的復健治療與近期發展

吞嚥障礙是腦中風常見的併發症，和吸入、營養不良、脫水、失能有關，且會增加肺炎甚至死亡的風險。早期診斷及治療吞嚥障礙的病人不但可減少併發症，也可減少住院日數及總醫療支出。腦中風後口咽部吞嚥障礙有相當多樣性的吞嚥異常型態，症狀臨床不易診斷，腦中風病人在住院及以口進食前都應儘早接受吞嚥篩檢，未通過篩檢或有吞嚥風險的病人，需由語言治療師（或適當的專業人員）進行專業臨床評估，必要時需安排吞嚥儀器檢查，例如透視螢光吞嚥檢查或光纖內視鏡吞嚥檢查，以判定吞嚥障礙嚴重程度，了解吞嚥的生理異常，並引導治療的方向。腦中風後口咽部吞嚥障礙有許多的治療方法，包括代償策略與復健策略，有許多有潛力的治療方法漸出現，包括神經電刺激、用藥及加強吞嚥肌力的儀器等。建立多專業吞嚥團隊整合介入照護，可有效減少急性中風後肺炎的發生。雖然吞嚥復健是有效的，但腦中風後吞嚥障礙的處理仍屬被忽略的研究領域，未來仍需更多研究來找出最適宜的處置，包括診斷、評估及治療方法。

關鍵字

吞嚥障礙（dysphagia）；電刺激（electrical stimulation）；腦中風（stroke）；中風相關的肺炎（stroke-associated pneumonia）；吞嚥復健（swallowing rehabilitation）

並列摘要

Dysphagia is a common poststroke complication. It is associated with aspiration, malnutrition, dehydration, and disability, and it may increase the risk of pneumonia, and even death. Early diagnosis and treatment of patients with dysphagia reduces not only the aforementioned risks, but also the length of hospitalization and overall healthcare expenditures. Patients with poststroke oropharyngeal dysphagia exhibit highly variable patterns of swallowing abnormalities, and the related symptoms remain challenging to identify clinically. Patients who have experienced stroke should be screened for dysphagia as early as possible on admission and prior to any form of oral intake. Those who fail dysphagia screening or are evaluated to be at risk for dysphagia should be assessed by a speech-language pathologist (or an appropriate professional), where indicated investigation involving instrumental swallowing examinations such as videofluoroscopy or fiberoptic endoscopic evaluation of swallowing should be undertaken to determine the functional severity, understand the swallowing physiology and guide treatments. Treatment strategies for poststroke oropharyngeal dysphagia include compensatory and rehabilitation strategies. Promising therapies are emerging, including neurostimulation techniques and medication and devices to strengthen the muscles involved in swallowing. The establishment of a multidisciplinary swallowing team approach effectively reduces the risk of pneumonia in patients who have experienced acute stroke. Although swallowing rehabilitation is effective, the management of poststroke dysphagia remains a neglected area of research. More research is needed to determine the optimal management protocols in areas including diagnosis, investigation and treatment.

並列關鍵字

dysphagia ； electrical stimulation ； stroke ； stroke-associated pneumonia ； swallowing rehabilitation

參考文獻

Smithard DG, O’Neill P, England R, et al. The natural history of dysphagia following a stroke. Dysphagia 1997;12:188-93.

Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis 2000;10:380-6.

Paciaroni M, Mazzotta G, Corea F, et al. Dysphagia following stroke Eur Neurol 2004;51:162-7.

Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005;36:2756-63.

Arnold M, Liesirova K, Broeg-Morvay A, et al.Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PLoS One 2016;11:e0148424

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腦中風後吞嚥障礙的復健治療與近期發展

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