咀嚼吞嚥障礙、吸入性肺炎與口腔衛生不良的三角關係

The Triangular Relationship Among Swallowing Disorders, Aspiration Pneumonia, and Poor Oral Hygiene

咀嚼吞嚥障礙是指因機能上、構造上或心理的原因造成進食時食物不易咀嚼、吞嚥，造成嗆咳、誤吸或吸入到氣管、肺部。這些有咀嚼吞嚥障礙的病人常因喝水或刷牙時容易嗆咳，或因刷牙時會咬牙刷、或容易牙齦流血而減少刷牙的次數或不敢刷牙，以致牙周病、齲齒蔓延，甚至口腔咽喉部位堆積許多口咽分泌汙染物，造成大量細菌在口咽部位的定殖繁衍。當個案發生嗆咳或吸入時，這些細菌就會隨著嗆咳物吸入到氣管、肺部而造成吸入性肺炎。此外嗆咳的病人常被留置鼻胃管，以利營養、水分的供給。長期置放鼻胃管也有產生吸入性肺炎之高風險。因此，藉由進食姿勢的調整，食材質地的改善、吞嚥復健與訓練及口腔照護，則可以有效預防咀嚼吞嚥障礙及吸入性肺炎的發生。

Persons with dysphagia have difficulties chewing and swallowing food because of functional, structural, or psychological reasons. Dysphagia may cause choking or the inhalation of food into the trachea and lungs. Patients with dysphagia often induce the coughing reflex when drinking water and brushing teeth and tend to suffer from gum bleeding. As a result, their caregivers tend to reduce the frequency of or discontinue teeth brushing, which promotes the spread of periodontal disease, dental caries, and oropharyngeal secretions colonizing in the oral cavity or throat. When a patient suffers a choking attack or aspiration, bacteria is inhaled into the trachea and lungs, causing aspiration pneumonia. Furthermore, patients with choking issues are often be fitted with nasogastric tubes to facilitate the delivery of nutrients and water. Long-term use of nasogastric tubes also significantly increases the risk of aspiration pneumonia. Adjusting eating posture, improving food texture, conducting swallowing rehabilitation, providing training, and practicing proper oral care are an effective approach to preventing the onset of chewing and swallowing disorders and aspiration pneumonia.