經口氣管插管拔管後吞嚥困難

Post-extubation Dysphagia

經口氣管插管是重症病患為維持生命常接受的醫療處置，但氣管內管本身對於咽喉的接觸壓迫，使病患於拔管後容易產生吞嚥困難及進食障礙，稱之為拔管後吞嚥困難（post-extubation dysphagia, PED），影響病患生活品質甚鉅，然而於臨床上卻常被忽略。因此，本文簡介PED 之定義、機轉、危險因子、評估方式以及介入處置如口腔運動、口腔潤濕清潔、唾液腺按摩、神經刺激、飲食質地調整等，期能增進臨床照護者對PED 的認識，及早篩檢並予病患適當之處置、指導及轉介，使其能早日安全地由口進食。

Endotracheal intubation is life-sustaining but it may affect the structure and function of oropharynx and lead to post-extubation dysphagia (PED), resulting in a delay to oral intake. Little attention, however, has been paid. This review aims to introduce PED with its definition, pathophysiological mechanism, risk factors, and bedside screening and instrumental assessment. The potential swallowing and intake therapeutics such as oral motor exercises, cleaning and moisturizing of mouth and pharynx, salivary gland massage, nerve stimulation, and food texture modification are reviewed. We hope by increasing the awareness of PED among interdisciplinary professionals, early detection and timely intervention will be provided for the patients with PED.