吞嚥困難者之備餐

Food Preparation for Patients with Dysphagia

10.6317/LTC.201812_22(3).0002

郭雅婷(Ya-Ting Kuo)；陳慧君(Hui-Chuen Chen)

吞嚥困難 ； 食物製備 ； 食物質地 ； 營養密度 ； 增稠劑 ； dysphagia ； food preparation ； food texture ； nutrient density ； thickeners

長期照護雜誌

22卷3期（2018 / 12 / 01）

235 - 244

繁體中文

吞嚥困難是指因身體機能、構造或心理上的原因，造成食物從口腔經過咽部進入胃的過程出現困難。常見於失智、中風、頭頸部手術、柏金森氏症、肌肉萎縮、年齡老化等患者。症狀包含出現嗆咳、流口水、食物須分多次吞食、無法順利進食等，亦可能引起吸入性肺炎、脫水或營養不良。由於吞嚥困難患者普遍存在口咽肌肉和舌頭力量不足的問題，因此無法將過硬或纖維過粗的食物有效咀嚼為適合吞嚥的食糰，而唾液分泌量不足也會增加咽部吞嚥太過乾燥或黏稠食糰的困難度，因此為吞嚥困難者準備飲食最大的重點在於挑選適當的食物質地，並根據不同程度的吞嚥障礙，調整供應食物的入口大小、軟硬度、濕潤度與濃稠度。此外，為了改善此類患者脫水與營養不良的情況，在飲食準備方面，會以體積小但營養密度高者為優先；在液體補充過程為避免造成嗆咳，亦會搭配天然或商業增稠劑來加強安全度。

Dysphagia is defined as difficulty in food passage from mouth through pharynx to stomach, which might result from functional, structural deficits or psychological causes. It is commonly found in dementia, stroke, head and neck surgery, Parkinson's disease, muscular atrophy, and aging patients. The symptoms includes coughing, drooling of saliva, foods needed to be swallowed several times, and difficult swallowing. Furthermore, dysphagia could induce aspiration, dehydration or malnutrition. Due to tongue and oropharyngeal muscle weakness, hard solid or fibrous foods could not be masticated effectively to form suitable swallowable bolus. Insufficient saliva production enhances dryness of oropharyngeal area and difficulty of swallowing sticky foods. Therefore, The most important points of preparing foods for dysphagia are (1) choosing proper food texture, (2) according to stages of dysphagia, adjusting food particle size, hardness, moisture and thickness. In order to improve risk of patient's dehydration and malnutrition, preparing foods with small volume and high nutrient density is the first priority and adding natural or commercial thickeners to liquified foods to avoid of choking during liquid supplementation.

1. Alcázar-Alay, S. C.,Meireles, M. A. A.(2015).Physicochemical properties, modifications and applications of starches from different botanical sources.Food Science аnd Technology,35(2),215-236.
2. Bhat, Z. F.,Morton, J. D.,Mason, S. L.,Bekhit, A. E. D. A.(2018).Applied and emerging methods for meat tenderization: a comparative perspective.Comprehensive Reviews in Food Science and Food Safety,17(4),841-859.
3. Chumngoen, W.,Chen, C. F.,Tan, F. J.(2018).Effects of moist-and dry-heat cooking on the meat quality, microstructure and sensory characteristics of native chicken meat.Animal Science Journal,89(1),193-201.
4. Cichero, J. A. Y.(2016).Adjustment of food textural properties for elderly patients.Journal of Texture Studies,47(4),277-283.
5. Cichero, J. A.,Lam, P.,Steele, C. M.,Hanson, B.,Chen, J.,Dantas, R. O.,Stanschus, S.(2017).Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework.Dysphagia,32(2),293-314.
6. Cichero, J. A.,Steele, C.,Duivestein, J.,Clavé, P.,Chen, J.,Kayashita, J.,Murray, J.(2013).The need for international terminology and definitions for texture-modified foods and thickened liquids used in dysphagia management: foundations of a global initiative.Current Physical Medicine and Rehabilitation Reports,1(4),280-291.
7. Clavé, P.,Shaker, R.(2015).Dysphagia: current reality and scope of the problem.Nature Reviews Gastroenterology & Hepatology,12(5),259-270.
8. Dantas, R. O.,Kern, M. K.,Massey, B. T.,Dodds, W.,Kahrilas, P.,Brasseur, J.,Lang, I. M.(1990).Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing.The American Journal of Physiology,258(5),G675-G681.
9. Dietsch, A. M.,Pelletier, C. A.,Solomon, N. P. J. D.(2018).Saliva production and enjoyment of real-food flavors in people with and without dysphagia and/or xerostomia.Dysphagia,33(6),803-808.
10. Dunne, J. L.,Dahl, W. J.(2007).A novel solution is needed to correct low nutrient intakes in elderly long-term care residents.Nutrition Reviews,65(3),135-138.
11. Eglseer, D.,Halfens, R. J. G.,Schols, J. M. G. A.,Lohrmann, C.(2018).Dysphagia in hospitalized older patients: associated factors and nutritional interventions.The Journal of Nutrition, Health & Aging,22(1),103-110.
12. Groher, M.,Crary, M.(2010).Dysphagia: clinical management in adults and children.Missouri:Mosby.
13. Gupta, A.,Epstein, J. B.,Sroussi, H.(2006).Hyposalivation in elderly patients.Journal (Canadian Dental Association),72(9),841-846.
14. Jin, H.,Kim, B.,Han, J.(2017).Development and characterization of thickeners using natural materials.Korean Journal of Food Science and Technology,49(3),229-234.
15. Keller, H. H.,Duizer, L. M.(2014).What do consumers think of pureed food? Making the most of the indistinguishable food.Journal of Nutrition in Gerontology and Geriatrics,33(3),139-159.
16. Kim, H. W.,Choi, Y. S.,Choi, J. H.,Kim, H. Y.,Lee, M. A.,Hwang, K. E.,Kim, C. J.(2013).Tenderization effect of soy sauce on beef M. biceps femoris.Food Chemistry,139(1-4),597-603.
17. Kwon, S. H.,Park, H. R.,Lee, Y. M.,Kwon, S. Y.,Kim, O. S.,Kim, H. Y.,Lim, Y. S.(2017).Difference in food and nutrient intakes in Korean elderly people according to chewing difficulty: using data from the Korea National Health and Nutrition Examination Survey 2013 (6th).Nutrition Research and Practice,11(2),139-146.
18. Lorenzo, J. M.,Cittadini, A.,Munekata, P. E.,Domínguez, R.(2015).Physicochemical properties of foal meat as affected by cooking methods.Meat Science,108,50-54.
19. Martin, A. W.(1991).Dietary management of swallowing disorders.Dysphagia,6(3),129-134.
20. Moret-Tatay, A.,Rodríguez-García, J.,Martí-Bonmatí, E.,Hernando, I.,Hernández, M. J.(2015).Commercial thickeners used by patients with dysphagia: rheological and structural behaviour in different food matrices.Food Hydrocolloids,51,318-326.
21. Newman, R.,Vilardell, N.,Clavé, P.,Speyer, R.(2016).Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: white paper by the European Society for Swallowing Disorders (ESSD).Dysphagia,31(2),232-249.
22. Pelletier, C. A.(1997).A comparison of consistency and taste of five commercial thickeners.Dysphagia,12(2),74-78.
23. Shimizu, A.,Maeda, K.,Tanaka, K.,Ogawa, M.,Kayashita, J.(2018).Texture-modified diets are associated with decreased muscle mass in older adults admitted to a rehabilitation ward.Geriatrics & Gerontology International,18(5),698-704.
24. Smith, H. A.,Kindell, J.,Baldwin, R. C.,Waterman, D.,Makin, A. J.(2009).Swallowing problems and dementia in acute hospital settings: practical guidance for the management of dysphagia.Clinical Medicine,9(6),544-548.
25. Vucea, V.,Keller, H. H.,Morrison, J. M.,Duizer, L. M.,Duncan, A. M.,Carrier, N.,Steele, C. M.(2018).Modified texture food use is associated with malnutrition in long term care: an analysis of Making the Most of Mealtimes (M3) project.The Journal of Nutrition, Health & Aging,22(8),916-922.
26. Vucea, V.,Keller, H. H.,Morrison, J. M.,Duncan, A. М.,Duizer, M.,Carrier, N.,Slaughter, S. E.(2017).Nutritional quality of regular and pureed menus in Canadian long term care homes: an analysis of the Making the Most of Mealtimes (M3) project.BMC Nutrition,3(1),80.
27. Wirth, R.,Pourhassan, M.,Streicher, M.,Hiesmayr, M.,Schindler, K.,Sieber, C. C.,Volkert, D.(2018).The impact of dysphagia on mortality of nursing home residents:results from the nutritionDay project.Journal of the American Medical Directors Association,19(9),775-778.
28. 王亭貴,陳思遠,連倚南,黃士峰(2001)。臺北某社區老人之吞嚥障礙。臺灣醫學，5(5)，523-529。
29. 松本七織(2017)。畜肉軟化における各種調理法の研究。東京家政学院大学紀要，57，189-192。
30. 陳惠旻(2018)。質地軟化技術於肉類蛋白食品之應用。食品工業月刊，50(5)，42-51。

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