增進體能，減少鼻胃管置入──無管人生

Improve Physical Fitness and Reduce Nasogastric Tube Insertions: Working to Achieve a‘No Tube’Life

臨床上常見病人因吞嚥困難導致進食量少，營養不良、或是因為經常嗆咳導致吸入性肺炎。放置鼻胃管灌食的目的是作為營養與水分補充的途徑以及預防由口進食造成嗆入。已知明確原因的吞嚥困難可藉由內外科的治療改善，但是對於退化性疾病而言，則須仰賴營養支持與復健治療， 增強肌肉力量與協調性，減少日後放置鼻胃管的機率。一般針對吞嚥困難的肌力訓練會聚焦在吞嚥、呼吸相關的肌肉，但是若觀察人體正常的進食動作，需下肢肌群與軀幹肌群的協調運作， 以支撐人體的重量並維持姿勢穩定，接著拿取食物時則須仰賴上肢肌群的活動，所以，若可以實施相關肌肉群的訓練，亦可減少因肌力的減退造成的進食困難。本文收集改善衰弱之相關實證文獻證據，並提供增進體能方案之原則及實務操作建議，包括呼吸肌強化訓練、坐姿及平衡能力訓練、上肢肌力訓練及下肢肌力訓練，希望做為臨床實務之參考。

"It is common in clinical settings for patients to suffer from dysphagia-related malnutrition and coughing-related aspiration pneumonia because of reduced levels of food intake. Nasogastric tube feeding provides nutrition and water and prevents choking related to oral feeding. Although dysphagia is often treated using medical and surgical treatments, degenerative-disease-related dysphagia is currently widely treated using nutritional support and rehabilitation to enhance muscle strength and coordination and reduce the risk of nasogastric tube placement in the future. Generally, the focus of muscle strength training for dysphagia is on muscle training related to swallowing and breathing. However, the process of eating requires the coordinated operation of the muscles of the lower limbs and the trunk to support the body’s physical weight and maintain stable posture. When consuming food, an individual must rely on the activities of the upper limb muscles. Therefore, training the relevant muscles may effectively reduce the eating difficulties caused by muscle strength loss. In this article, empirical literature evidence related to improving frailty is collected and principles and practical suggestions are provided for improving physical fitness programs, including breathing muscle strengthening training, sitting and balance training, upper limb muscle strength training, and lower limb muscle strength training. It is hoped that the findings will be used as a guide in clinical practice."