中風病人吞嚥困難的比率及治療成效初探－以新竹某區域教學醫院為例

The Dysphagia Percentage of Patients with CVA and the Effectiveness of Speech Therapy - A Pilot Study in a Regional Teaching Hospital in Hsinchu

10.6143/JSLHAT.2017.06.04

盧采臻(Cai-Jhen Lu)；張麟鳳(Lin-Feng Chang)；洪蘆妍(Lu-Yean Hung)；彭淑苹(Shu-Ping Peng)

吞嚥困難 ； 發生率 ； 治療成效 ； 吞嚥治療 ； Dysphagia ； Prevalence ； Effectiveness ； Swallow therapy

台灣聽力語言學會雜誌

36期（2017 / 06 / 01）

35 - 46

繁體中文

吞嚥困難是中風者常見的併發症，約占腦中風發病率的74.2%，但接受吞嚥治療的比率卻偏低，吞嚥篩檢表的使用及早期吞嚥治療的介入，將有助於改善病人的吞嚥困難情形。因此，本研究旨在探究住院病人中，因中風導致吞嚥困難的比率、吞嚥困難者接受吞嚥治療的比率、及吞嚥治療的成效。本研究共收取72位主要疾病為中風之住院病人，使用雀巢公司與Dr. Belafsky所研發的吞嚥困難自我評估表（中文版EAT-10）進行研究與分析。分析結果得知中風病人的吞嚥困難比率為74%，但接受吞嚥治療的比率僅有51%。本研究針對轉介給語言治療師之病人安排密集性的吞嚥治療（每週五次，為期二週），並於第五和第十次吞嚥治療後，皆以EAT-10評估其吞嚥困難情形，進而分析治療成效，病人在接受五次治療後，即可有效改善吞嚥困難的情形（p = 0.000）；在接受十次治療後，更可有效改善其在日常生活中的進食方式（p = 0.000），有近半數（48.15%）的吞嚥困難者在十次治療後，吞嚥困難程度改善至輕度吞嚥困難、或是無吞嚥困難。因中風造成吞嚥困難的比率偏高，但在本研究中接受吞嚥治療的比率僅有五成。研究結果發現，在中風初期以吞嚥篩檢表篩選出疑似吞嚥困難者，並依吞嚥篩檢的結果，轉介病人接受吞嚥治療，將可配合病患的自發性恢復能力，而有效改善吞嚥困難的情形。未來若能以EAT-10作為臨床醫護人員吞嚥篩檢的工具，將可有效提高接受治療的比率，並改善其吞嚥困難程度。

Dysphagia is a common complication during patients with CVA (cerebral vascular accident), which percentage is 74.2%; however, the percentage of receiving swallow therapy is relatively low. Recently, it has been found that the use of swallow scanning chart and early intervention of swallow therapy would help dysphagic patients improve their swallowing difficulties. As a result, the present study will discuss about the percentage of dysphagic inpatients, the percentage of receiving swallow therapy of them and the effectiveness of the therapy. The present study includes 72 CVA inpatients, and their dysphagic problem will be assessed by EAT-10 in Chinese version, which is a self-evaluating assessment developed by Dr. Belafsky, and the collected data will be analyzed. The result shows that the percentage of inpatients with dysphagia is 74%, but only 51% of them undergoing swallow therapy. Those inpatients referred to speech-language pathologist (SLP) will receive intensive swallowing therapy, which means five times per week for 2 weeks, and they will be reevaluated by EAT-10 after the fifth and tenth therapy for a better understanding of the effectiveness of the therapy. It is found that dysphagia is effectively improved after the therapy for five times (p = 0.000), and their daily eating is also significantly improved after the tenth therapy. Besides, there are nearly half (48.15%) of severe dysphagic inpatients become mild dysphagia or get total recovery from it. It is also found that the percentage of dysphagia caused by CVA is high, but there are only 50%of them receiving swallow therapy. We find that if we can scan suspected dysphagic patients in the early stage of CVA and refer them to SLP for swallow therapy according to the scanning, the dysphagic problem will be effectively resolved along with their spontaneous recovery. Furthermore, The use of EAT-10 as a scanning tool will help clinical medical personnel find out dysphagic inpatients, which will be positively increase the proportion of referring patients in-need to SLP and improve their dysphagic problem.

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