腦中風病患吞嚥障礙之評估與護理處置

Dysphagia Assessment and Nursing Implementation for Patients With Stroke

腦中風病患發生吞嚥障礙比率為30-60%。吞嚥障礙容易造成腦中風病患吸入性肺炎、營養不良及延長住院時間。護理人員應有能力運用吞嚥功能篩檢評估技巧與相關護理處置方式，以降低腦中風病患吸入性肺炎與營養不良的發生率。初步篩檢病患吞嚥功能是否受損、病患整體性評估、確認吞嚥障礙的徵兆、喉部上提理學檢查及床邊喝水試驗皆可用來輔助評估吞嚥功能。當病患確診有吞嚥障礙時，護理處置包括：口腔主動性運動、食物質地選擇、調整進食姿勢、輔具使用及用餐環境控制，以促進病患吞嚥功能之改善。

Thirty to sixty percent of patients with stroke have experienced dysphagia. Dysphagia easily causes aspiration pneumonia, malnutrition, and prolonged hospitalization among stroke patients. If neurologic nurses can appropriately apply dysphagia evaluation skills and relevant nursing implementations, the incidence of aspiration pneumonia and malnutrition among stroke patients could be indirectly reduced. The first step is to identify the swallowing function of stroke patients. Preliminary screening, overall assessment, confirmed symptoms of dysphagia, larynx elevation physical examination and bedside water testing can be used to assist in evaluating swallowing function. When patients’ dysphagia is confirmed, the implementation of care methods, including active oral exercises, selection of food textures, adjustment of food consumption posture, use of assistive devices and control of dining environments can improve swallow function recovery for stroke patients.