經氣管內管插管後病人口腔感覺、舌運動功能與唾液分泌變化

Abstract

長期插管可能會造成口腔體感覺功能閾值的增加、唾液分泌的減少以及舌肌肉力量的減退，以上這些功能都會影響到病人拔管後經口進食的情況。本研究目的為探討接受口咽氣管內管插管大於48小時病人，其舌及嘴唇肌肉力量、口腔體感覺功能與唾液分泌功能的影響及其拔管後復原狀況。 收案期間自民國101年8月至民國101年12月止，分別於台大牙科門診收健康控制組，共36人，予以一次性Modified Schirmer test(MST)、兩點辨識覺、輕觸覺、口腔形體辨識覺、舌等長收縮、與嘴唇肌力的評估。台大內科加護病房(3A-2、3B-2、3C-1、3C-2、4C-1、6E)，收長期接受口咽氣管內管插管且成功拔管的病人共30人，於成功拔除氣管內管四十八小時內，收案並完成拔管後首次Modified Schirmer test(MST)、兩點辨識覺、輕觸覺、口腔形體辨識覺、舌等長收縮、與嘴唇肌力及之後第七天、第14天的追蹤評估。 結果發現，插管病人其舌及嘴唇肌肉力量、口腔體感覺功能與唾液分泌功能在拔管後48小時處於最低點，而口腔體感覺功能到第14天大部分病人都能恢復，而舌及嘴唇肌肉力量與唾液分泌功能及便到第14天仍顯著低於健康控制組。

Loss of oral sensation, declined salivary secretion, and decreased tongue strength may occur after prolonged endotracheal intubation. All the above may affect oral intake following endotracheal extubation. The aim of this study was to assess the functional recovery of oral sensation, salivary secretion, and tongue strength in patients with prolonged endotracheal intubation. A prospective observation study was conducted to assess the functional recovery of oral sensation, salivary secretion, and tongue strength among patients aged 20 years and older following endotracheal extubation. In keeping with previous research, we only include patient who had been intubation for at least 48hours.Data were assessed at three points in time, 48 hours within extubation, and 7 days and 14 days postextubation. Specifically , salivary secretion was measured by oral Schirmer test ; oral sensation was measured by oral stereognosis ,two point discrimination and light touch discrimination on the tongue ;tongue strength was measured by the Iowa Oral Performance Instrument(IOPI) System .The sample consists 30 patients and 36 control. Data revealed that oral sensation, salivary secretion, and tongue strength were all at the lowest point 48 hours within extubation. Oral sensation gradually recovered 14 days after extubation, while salivary secretion and tongue strength did not improve even at 14 days after extubation. The result suggests that functions of oral sensation, salivary secretion, and tongue strength affected significantly after prolonged endotracheal intubation and most did not recovered even after 14 days.