應用「吞嚥障礙問題分析暨照顧樹狀圖」對改善食道癌吸入性肺炎及治療完成率之探討

Application of ''Decision-Making Tree of Dysphagia Problem Analyses and Management'' to Improve the Incidence of Aspiration Pneumonia and Treatment Completion Rate in Esophageal Cancer

背景：「吞嚥障礙」是導致食道癌病人營養不足與吸入性肺炎的主因，它會加重病人治療時的體力負荷使耐受力降低，可能會導致治療中斷進而影響療效。目的：探討「吞嚥障礙問題分析暨照顧樹狀圖」對改善食道癌病人接受放射線治療合併化學治療期間，吸入性肺炎發生率與治療完成率的成效。方法：類實驗重覆測量研究設計，共收案30位食道癌病人。運用「吞嚥障礙問題分析暨照顧樹狀圖」介入處置，進行吞嚥障礙篩檢評估、問題確立、照顧計畫與個別衛生指導計畫，為期50天連續追蹤每位個案放射線治療合併化學治療期間，以確認其介入效益。結果：應用「吞嚥障礙問題分析暨照顧樹狀圖」於30位食道癌病人化學合併放射治療期間之吞嚥障礙問題之照顧具可行性，83.3％出現吞嚥障礙。且個案吸入性肺炎發生率為3.3％，治療完成率達96.7％。結論：應用樹狀圖早期評估與處置食道癌病人的吞嚥障礙，有助於治療期間改善吸入性肺炎的發生與治療完成率，日後可作為醫療團隊建構本土性「食道癌合併吞嚥障礙」臨床照護指引之參考。

Background: ''Dysphagia'' is a leading cause of malnutrition and aspiration pneumonia in patients with esophageal cancer. It might increase physical burden leading to reduce tolerance for cancer treatment and interfere with therapy efficacy. Purpose: The study aims to apply e ''decision-making tree dysphagia classification and management'' to improve the incidence of aspiration pneumonia and the rate of completion of treatment in esophageal cancer patients while receiving concurrent chemo-radiotherapy (CCRT). Methods: This was a quasi-experimental study with a total of 30 patients. The application of a ''decision-making tree dysphagia classification and management'' involved in the treatment of dysphagia screening assessment, problem analyses, care plan and individualized health guidance program, and continuously followed each case for 50 days during the period of CCRT. Results: The application of ''decision-making tree dysphagia classification and management'' in 30 esophageal cancer patients was feasible. The incidence of dysphagia was 83.3%; the incidence of aspiration pneumonia was 3.3%; and the treatment completion rate was 96.7 %. Conclusion/Implications for practice: Application of the decision-making tree could early assess and manage esophageal cancer patients with dysphagia to improve the incidence of aspiration pneumonia and treatment completion rate. The results from this study might provide healthcare providers with a reference to develop clinical guideline for dysphagia in patients with esophageal cancer.