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

The Prevalence and Signs of Dysphagia among Stroke Patients in Rehabilitation Units

背景：咀嚼吞嚥障礙是腦中風病患常見的障礙之一，且伴隨許多併發症，如吸入性肺炎、營養失調、住院天數增加等。綜觀國內外的研究，多是針對急性期來探討咀嚼吞嚥障礙及其對預後的影響，針對轉入復健期後的病患咀嚼吞嚥障礙的評估應持續進行但其相關研究卻較少。目的：探討復健期腦中風病患的咀嚼吞嚥障礙盛行率及咀嚼吞嚥障礙徵象指標。方法：本研究以方便取樣於南部某醫學中心之復健科病房進行收案，符合收案條件者進行基本資料收集及臨床相關檢查資料之蒐集，以反覆性唾液吞嚥試驗法（repetitive saliva swallowing test, RSST）與改良式喝水測試（modified water swallowing test, MWST）來評估病患是否有咀嚼吞嚥障礙，咀嚼吞嚥障礙的定義為無法完成RSST或MWST其中一種測試。本研究採用JMP 9.0進行資料統計分析，包括描述性統計、t檢定、卡方檢定與邏輯迴歸分析。結果：本研究結果顯示53.61%的病患有咀嚼吞嚥障礙。「是否可以緊閉嘴唇含水」、「會咀嚼但無法咬碎」、「吞嚥後食物是否卡在喉嚨」、「吞嚥後是否有痰液聲出現」、「喝水是否嗆咳」這五種與咀嚼吞嚥障礙有關的徵象呈現出顯著性差異。進一步以多變項邏輯迴歸分析結果顯示「喝水是否嗆咳」為咀嚼吞嚥障礙之重要指標。結論：中風後的復健期，仍有半數以上病患有咀嚼吞嚥障礙的表現，第一線照護病患的護理人員，亦須同時具備咀嚼吞嚥障礙相關的知識與訓練，以提升病患照護安全。

Background: Dysphagia, a very common post-stroke symptom, has been linked to aspiration pneumonia, malnutrition, and increased length of hospitalization. While patients are typically monitored for dysphagia continuously following their transfer to a rehabilitation unit, little is known about the results of dysphagia reassessments.Purpose: This study investigates the prevalence and signs of dysphagia among stroke patients in rehabilitation units.Methods: We analyzed patients with stroke admitted to a rehabilitation unit of a medical center in southern Taiwan. The procedure included chart review, the repetitive saliva swallowing test (RSST), and the modified water swallowing test (MWST). Dysphagia was defined as either RSST or MWST abnormal. JMP 9.0 was used to perform descriptive statistics, t-test, chi-square test and logistic regression analysisResults: At clinical examination, 53.61% of the study subjects demonstrated dysphagia. Chi-square analysis showed that five abnormal signs (could not close mouth with water, without mastication, food stuck in the throat, obvious sputum sound, and choking after swallowing) are all associated with dysphagia. Multiple logistic regression analysis revealed choking is a significant predictor variable of dysphagia.Conclusion: Over half of the rehabilitation unit stroke patients in this study had dysphagia. Nurses are the primary care providers for dysphagia patients. Therefore, there is a need for ward nurses to have skills to assess, recognize, and manage dysphagia and to enhance patient safety.