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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳佳慧(Chia-Hui Chen) | |
dc.contributor.author | Chung-Pei Wu | en |
dc.contributor.author | 吳崇珮 | zh_TW |
dc.date.accessioned | 2021-06-15T13:43:24Z | - |
dc.date.available | 2017-12-17 | |
dc.date.copyright | 2016-08-29 | |
dc.date.issued | 2015 | |
dc.date.submitted | 2015-12-18 | |
dc.identifier.citation | 中文部份
內政部統計處(2012)•民國98年老人狀況調查摘要分析•2014年5月30日•取自sowf.moi.gov.tw/stat/Survey/98old.doc。 吳亭瑤、陳惠滿(2009)•一位腦幹中風導致吞嚥障礙患者之護理經驗•志為護 理-慈濟護理雜誌,8(3),91-99。むWu, T.Y., & Chen h.NM. (2009). Nursing Experiencing with a Patient with Dysphagia Caused by Brain Stem Infarction. Tzu Chi Nursing Journal, 8(3), 91-99め 吳國湘(2014)•長期經口插管對口腔及咽部結構、構音發聲功能的影響•(未出 版的碩士論文).台北市:國立台灣大學。むWu, K.H.(2014).The Effects on Oral and Pharyngeal Structures, Articulation and Phonation Functions following Prolonged Endotracheal Intubation. (Unpublished dissertation) .National Taiwan University: Taipeiめ 吳國湘、蕭自佑、古世基、陳佳慧(2014)•長期經口氣管插管在口腔、咽、喉及氣管之合併症•臺灣醫學,18(5),580-584。むWu, K.H., Hsiao, T.Y., Ku, S.C.& Chen, C.H. (2014).Oral, Pharyngeal, and Laryngotracheal Complications after Prolonged Oral Endotracheal Intubation. Formosa Journal of Medcine, 18(5), 580-584め 吳紹歆、彭素貞(2012)•口腔照護頻次對氣管內管留置病人口腔健康之成效• 榮總護理,29(3),225-223。むWu, S.S.& Pong, S.C. (2012). Effectiveness of Oral Care Frequency in the Oral Health of Patients With Endotracheal Tube Intubation. Veterans General Hospital Nursing, 29(3), 225-223.め 林盈秀、張榮珍、張慈惠、羅美芳(2009)•經口氣管內管留置病人口腔護理方式與步驟之觀察研究.護理雜誌,56(6),27-35。むLin, Y.S., Chang, J.C., Chang, T.H.& Luo, M.F. (2009).Oral Care Practice and Procedures in Intubated Patients: An Observational Study. The Journal of Nursing, 56(6), 27-35め 施至遠、陳人豪(2008)•老年人吞嚥障礙之評估與處置•長期照護雜誌, 12(4),337-346。 婁培人、陳文彬、李憲彥、徐茂銘(1997)•唾液腺的神經支配•中華民國耳鼻喉科醫學會雜誌,3(3),297-303。むLou, P.J., Chen, W.B., Lee, S.Y. & Hsu, M.W. (1997). Innervation of the Saliva Glands. The Journal of Taiwan Otolaryngology-Head and Neck Surgery. 3(3), 297-303.め 陳妙言、林麗嬋(2010)•吞嚥障礙之概念分析•護理雜誌,57(1),100-105。むChen, M.Y.& Lin, L.C. (2010). Concept Analysis of Dysphagia. The Journal of Nursing, 57(1), 100-105.め 陳妙言、盛華、陸清松、吳肖琪、林麗嬋(2000).吞嚥訓練護理方案對改善巴金森氏病患者吞嚥障礙成效之前驅研究.護理研究,8(4),396-408。むChen, M.Y., Shen, H., Wu, S.C., Lin, L.C. (2000). The Effectiveness of Swallowing Training in Improving the Impaired Swallowing of Patients With Parkinson's Disease: A Pilot Study. The Journal of Nursing Research, 8(4), 396-408.め 湯依寧、官大紳(2004)•老年人的吞嚥問題•台灣老年醫學會刊,48,1-3。 黃光雨(2011)•急性腦中風吞嚥困難篩檢•台大腦中風中心會訊,18(1), 9-10。 蔡旻璇(2013)•比較長期經口插管之年輕及老年病人其拔管後吞嚥功能之變化(未出版的碩士論文).台北市:國立台灣大學。むTsai, M.H. (2013). A comparison Study of Swallowing Function between Younger and Older patients with prolonged Oral Intubation. (Unpublished dissertation). National Taiwan University: Taipei.め 蔡旻璇、吳國湘、蘇涵、陳佳慧(2012)•經口氣管插管於口咽及吞嚥功能的影響.重症醫學雜誌,13(4),185-189。むTsai, M.H., Wu, K.H., Su, H. & Chen, C.H. (2012). Oropharyngeal and Swallowing Functions after Prolonged Oral Endotracheal Intubation. Taiwan Critical Care Medicine, 13(4), 185-189め。 蔡旻璇、陳佳慧(2013)•老化影響吞嚥功能的機轉•台灣醫學,17(1),1-3。 むTsai, M.H., & Chen, C.C-H. (2013). Age Effects on Swallowing Mechanism, Formosa Journal of Medcine, 17(1), 1-3.め 蔡恒惠(2012)•高齡者與住院病患的口腔照護•新臺北護理期刊,14(1),1-5。むTsai, H.H. (2012). Oral Care in the Elderly and Hospitalized Inpatients. New Taipei Journal of Nursing, 14(1), 1-5め 歐陽來祥、劉心怡(2011)•吞嚥困難評估和治療臨床實用手冊(初版二刷)•台北:心理出版社。 謝春蘭、蔡艷雲、許榕珊、陳麗貞(2013)•提升加護病房口咽氣管內管留置病人口腔清潔之正確性•志為護理-慈濟護理雜誌,12(1), 88-97。むHsieh, C.L., Tsai, Y.Y., Hsu, J.S. & Chen, L.C. (2013).Improving the Accuracy of the ICU Oropharynx Trachea Tube Intubating Patients’ Oral Hygiene, Tzu Chi Nursing Journal, 12(1), 88-97.め 蘇涵(2013)•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 (未發表的碩士論文)•台北市:臺灣大學護理學研究所碩士班。むSu, H. (2013). Oral Sensation, Salivary Secretion and Tongue Strength Following Endotracheal Tube Extubation (Unpublished dissertation). National Taiwan University: Taipeiめ 英文部分 Adams V, Mathisen B, Baines S, Lazarus C, Callister R. (2013). A systematic review and meta-analysis of measurements of tongue and hand strength and endurance using the Iowa Oral Performance Instrument (IOPI). Dysphagia, 28(3), 350-69. American Dental Association (2007). A look at toothbrushes. Journal of American Dental Association, 138, 1288 Barker, J., Martino, R., Reichardt, B., Hickey, E. J., & Ralph-Edwards, A. (2009). Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery. Canadian Journal of Surgery, 52(2), 119. Barnason, S., Graham, J., Wild, M. C., Jensen, L. B., Rasmussen, D., Schulz, P., ... & Carder, B. (1998). Comparison of two endotracheal tube securement techniques on unplanned extubation, oral mucosa, and facial skin integrity. Heart & Lung: The Journal of Acute and Critical Care, 27(6), 409-417. Boliek, C. A., Rieger, J. M., Li, S. Y. Y., Mohamed, Z., Kickham, J., & Amundsen, K. (2007). Establishing a reliable protocol to measure tongue sensation. Journal of Oral Rehabilitation, 34(6), 433-441. Bordon, A., Bokhari, R., Sperry, J., Testa IV, D., Feinstein, A., & Ghaemmaghami, V. (2011). Swallowing dysfunction after prolonged intubation: analysis of risk factors in trauma patients. The American Journal of Surgery, 202(6), 679-683. Brodsky, M.B., Gellar, J.E., Dinglas, V.D., Colantuoni, E., Mendez-Tellez, P.A., Shanholtz, C.,….& Needham, D. M. (2014). Duration of oral endotracheal intubation is associated with dysphagia symptoms in acute lung injury patients. Journal of Critical Care, 29(4),574-579. Burkhead, L. M., Sapienza, C. M., & Rosenbek, J. C. (2007). Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia, 22(3), 251-265. Butler, S. G., Stuart, A., Leng, X., Rees, C., Williamson, J., & Kritchevsky, S. B. (2010). Factors influencing aspiration during swallowing in healthy older adults. Laryngoscope, 120(11), 2147-2152. doi:10.1002/lary.21116 Charney, P., & Malone, A. (2009). ADA pocket guide to nutrition assessment. American Dietetic Association. Chen, A., Wai, Y., Lee, L., Lake, S., & Woo, S.B. (2005). Using the modified Schirmer test to measure mouth dryness: A preliminary study. The Journal of the American Dental Association, 136(2), 164-170. Chiba, Y. (2013). Short-Term Effectiveness of a Swallowing Exercise for the Elderly Using Day-Care Services. Journal of Nursing and Care, 5, 2167-1168. doi: 10.4172/2167-1168.S5-012 Clavé, P., Rofes, L., Carrión, S., Ortega, O., Cabré, M., Serra-Prat, M., & Arreola, V. (2012). Pathophysiology, relevance and natural history of oropharyngeal dysphagia among older people. Stepping Stones to Living Well with Dysphagia. Nestlé Nutr Inst Workshop Ser. Nestec Ltd.,, 72, 57-66. doi:DOI:10.1159/000339986 Crary, M. A., Mann, G. D. C., & Groher, M. E. (2005). Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Archives of Physical Medicine and Rehabilitation, 86(8), 1516‐1520. Davis, C. C., & Marks, J. E. (1986). The use of the Schirmer tear test in evaluating mouth dryness. Dental Hygiene, 60(3), 116-119, 129. Dennesen, P., Van Der Ven, A., Vlasveld, M., Lokker, L., Ramsay, G., Kessels, A., ... & Veerman, E. (2003). Inadequate salivary flow and poor oral mucosal status in intubated intensive care unit patients. Critical care medicine, 31(3), 781-786. de Larminat, V., Montravers, P., Dureuil, B., & Desmonts, J.‐M. (1995). Alteration in swallowing reflex after extubation in intensive care unit patients. Critical Care Medicine, 23(3), 486‐490. Divatia, J.V., Bhowmick, K. (2005). Complications of endotracheal intubation and other airway management procedures. Indian Journal of Anesthesia, 49(4), 308‐318. Eilers, J., Berger, A. M., & Petersen, M. C. (1988). Development, testing, and application of the oral assessment guide. Oncology Nursing Forum, 15(3), 325‐330. El Solh, A., Okada, M., Bhat, A., & Pietrantoni, C. (2003). Swallowing disorders post orotracheal intubation in the elderly. Intensive care medicine, 29(9), 1451-1455. Farri, A., Accornero, A., & Burdese, C. (2007). Social importance of dysphagia: its impact on diagnosis and therapy. Acta otorhinolaryngologica italica, 27(2), 83-86 Goldsmith, T. (2000). Evaluation and treatment of swallowing disorders following endotracheal intubation and tracheostomy. International Anesthesiology Clinics, 38(3), 219‐242. Heffner, J. E. (2010). Swallowing Complications After Endotracheal Extubation: Moving From “Whether” to “How”. CHEST, 137(3), 509-510. Hiraba, H., Inoue, M., Gora, K., Sato, T., Nishimura, S., Yamaoka, M., ... & Ueda, K. (2014). Facial Vibrotactile Stimulation Activates the Parasympathetic Nervous System: Study of Salivary Secretion, Heart Rate, Pupillary Reflex, and Functional Near-Infrared Spectroscopy Activity. BioMed research international, 2014, 1-9.doi:10.1155/2014/910812. Huehns, T. Y., Yentis, S. M., & Cumberworth, V. (1994). Apparent massive tongue swelling A complication of orotracheal intubation on the Intensive Care Unit. Anaesthesia, 49(5), 414-416. Humbert, I. A., & Robbins, J. (2008). Dysphagia in the elderly. Physical medicine and rehabilitation clinics of North America, 19(4), 853-866. Hwang, C.H., Choi, K.H., Ko, Y.S.& Leem, C.M. (2007). Pre-emptive swallowing stimulation in long-term intubated patients. Clinical Rehabilitation, 21, 41-46. Ibayashi, H., Fujino, Y., Pham, T.M. & Matsuda, S. (2008). Intervention Study of Exercise Program for Oral Function in Healthy Elderly People, The Tohoku Journal of Experimental Medicine, 215(3), 237-245. Kang, J. H., Park, R. Y., Lee, S. J., Kim, J. Y., Yoon, S. R., & Jung, K. I. (2012). The effect of bedside exercise program on stroke patients with dysphagia. Annals of Rehabilitation Medicine, 36(4), 512-520. Ko, S. H., Shin, Y. B., Min, J. H., Shin, M. J., Chang, J. H., Shin, Y. I., & Ko, H. Y. (2013). Botulinum Toxin in the Treatment of Drooling in Tetraplegic Patients With Brain Injury. Annals of rehabilitation medicine, 37(6), 796-803. Kotz, T., Federman, A. D., Kao, J., Milman, L., Packer, S., Lopez-Prieto, C., ... & Genden, E. M. (2012). Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Archives of Otolaryngology–Head & Neck Surgery, 138(4), 376-382. Langmore, S. E., & Pisegna, J. M. (2015). Efficacy of exercises to rehabilitate dysphagia: A critique of the literature.International journal of speech-language pathology, 1-8. López-Jornet, P., Camacho-Alonso, F., & Bermejo-Fenoll, A. (2006). A simple test for salivary gland hypofunction using Oral Schirmer's test. Journal of Oral Pathology & Medicine, 35(4), 244-248. Loret, C. (2015). Using sensory properties of food to trigger swallowing: A review. Critical Reviews in Food Science and Nutrition, 55(1), 140-145. Macht, M., White, S.D., & Moss, M. (2014) Swallowing Dysfunction After Critical Illness. Chest, 146(6), 1681-1689. Macht, M., Wimbish, T., Bodine, C. &Moss, M. (2013). ICU-Acquired Swallowing Disorder, the Society of Critical Care Medicine, 41(10), 2396-2405 Matsuo, K. (2011). Preventing aspiration pneumonia by oral health care. JMAJ, 54(1), 39-43. Matsuo, K., & Palmer, J. B. (2008). Anatomy and physiology of feeding and swallowing: Normal and abnormal. Physical Medicine and Rehabilitation Clinics of North America,19(4), 691‐707. Matsuo, K., & Palmer, J. B. (2009). Coordination of mastication, swallowing and breathing. Japanese Dental Science Review, 45(1), 31-40. Nishino, T. (2013). The swallowing reflex and its significance as an airway defensive reflex. Frontiers in Physiology, 3, 1-6. Nishino, T., Sugimori, K.,Hiraga, K.,& Hond, Y. (1989). Influence of CPAP on reflex responses to tracheal irritation in anesthetized humans. Journal of Applied Physiology, 67(3), 954-958. Papas, A., Singh, M., Harrington, D., Rodriguez, S., Ortblad, K., Jager, M., & Nunn, M. (2006). Stimulation of salivary flow with a powered toothbrush in a xerostomic population. Special Care in Dentistry, 26(6), 241-246. Prendergast, V., Jakobsson, U., Renvert, S., & Hallberg, I. R. (2012). Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients: results of a randomized controlled trial. Journal of Neuroscience Nursing, 44(3), 134-146. Rassameehiran, S., Klomjit, S., Mankongpaisarnrung, C. & Rakvit, A. (2015). Postextubation Dysphagia. CHEST , 28(1), 18-20 Robbins, J., Butler, S. G., Daniels, S. K., Diez Gross, R., Langmore, S., Lazarus, C.L., . . . Rosenbek, J. (2008). Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. Journal of Speech, Language, and Hearing Research, 51(1), S276-300. doi:10.1044/1092-4388 Robbins, J., Gangnon, R. E., Theis, S. M., Kays, S. A., Hewitt, A. L., & Hind, J. A. (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatrics Society, 53(9), 1483‐1489. Robbins, J., Kays, S. A., Gangnon, R. E., Hind, J. A., Hewitt, A. L., Gentry, L. R., & Taylor, A.J. (2007). The effects of lingual exercise in stroke patients with dysphagia. Archives of physical medicine and rehabilitation, 88(2), 150-158. Rodrigues, E.T., Suazo, I.C., &Guimarães , A.S. (2009). Temporomandibular joint sounds and disc dislocation incidence after orotracheal intubation. Clinical Cosmetic and Investigational Dentistry, 2, 71-73. Sawatsubashi, M., Umezaki, T., Kusano, K., Tokunaga, O., Oda, M., & Komune, S. (2010). Age-related changes in the hyoepiglottic ligament: functional implications based on histopathologic study. American journal of otolaryngology, 31(6), 448-452. Shaw, G.Y., Sechtem, P.R., Searl, J., Keller, K., .Rawi, T.A., Dowdy, E. (2007). Transcutaneous neuromuscular electrical stimulation (VitalStim) curative therapy for severe dysphagia: myth or reality? Annals of Otology, Rhinology & Laryngology, 116(1), 36-44. Skoretz, S. A., Flowers, H. L., & Martino, R. (2010). The incidence of dysphagia following endotracheal intubation: A Systematic Review . Chest, 137(3), 665‐673. Sole, M. L., Klein, D. G., & Moseley, M. J. (2012). Introduction to Critical Care Nursing 6: Introduction to Critical Care Nursing. Elsevier Health Sciences. Speyer, R., Baijens, L., Heijnen, M., & Zwijnenberg, I. (2010). Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review. Dysphagia, 25(1), 40-65. doi:10.1007/s00455-009-9239-7 Steele, C.M. (2012). Exercise-Based Approaches to Dysphagia Rehabilitation. In Cichero, J. & Clave, P.(eds.), Stepping Stones to Living Well with Dysphagia.(pp.109-117). Nestle Nutritional Institute Workshop Serious, 72, 109-117. Su, H., Hsiao, T.Y., Ku, S.C., Wang, T.G.,Lee, J.J., Tzeng, W.C. …&Chen, C.C (2015), Tongue Weakness and Somatosensory Disturbance Following Oral Endotracheal Extubation. Dysphagia, 30(2), 188-195. Sugiyama, T., Ohkubo, M., Honda, Y., Tasaka, A.(2013). Effect of swallowing exercises in independent elderly. The Bulletin of Tokyo Dental College, 54(2), 109-115. Takeuchi, A., Taniguchi, T., Ishii, Y., Izumi, M., Furuya, K., Kato, K., ... & Asai, Y. (2011). 575: Association Between Length of Intubation and Development of Dysphagia in Critically Ill Patients. Critical Care Medicine, 39(12), 159. Tolep, K., Getch, C. L., & Criner, G. J. (1996). Swallowing dysfunction in patients receiving prolonged mechanical ventilation. CHEST Journal, 109(1), 167-172. Tsuruta, R., Oda, Y., Shintani, A., Nunomiya, S., Hashimoto, S., Nakagawa, T., ... & Yabe, S. (2014). Delirium and coma evaluated in mechanically ventilated patients in the intensive care unit in Japan: A multi-institutional prospective observational study. Journal of Critical Care, 29(3), 472-e1. Watando, A., Ebihara, S., Ebihara, T., Okazaki, T., Takahashi, H., Asada, M., …Sasaki, H.(2004). Daily oral care and cough reflex sensitivity in elderly nursing home patients. Chest, 126(4), 1066‐1070. Weber, S. (2002). Traumatic complications of airway management. Anesthesiology Clinics of North America, 20(3), 503-512. Wunsch, H., Linde-Zwirble, W. T., Angus, D. C., Hartman, M. E., Milbrandt, E. B., & Kahn, J. M. (2010). The epidemiology of mechanical ventilation use in the United States. Critical Care Medicine, 38(10), 1947-1953. Yao, L. Y., Chang, C. K., Maa, S. H., Wang, C., & Chen, C. C. H. (2011). Brushing teeth with purified water to reduce ventilator-associated pneumonia. Journal of Nursing Research, 19(4), 289-297. Yeh, S. J., Huang, K. Y., Wang, T. G., Chen, Y. C., Chen, C. H., Tang, S. C., ... & Jeng, J. S. (2011). Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit. Journal of the Neurological Sciences, 306(1), 38-41. Yoshino,A., Ebihara,T.,Ebihara,S.,Fuji,H., &Sasaki H. (2001). Daily oral care and risk factors for pneumonia among elderly nursing home patients. Journal of the American Medical Association, 286(18), 2235-2236. Zelles, T., Boros, I., & Varga, G. (1999). Membrane stretch and salivary glands—facts and theories. Archives of Oral Biology, 44, S67-S71. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/51661 | - |
dc.description.abstract | 研究背景與目的:
醫療技術發展迅速,接受經口插管合併呼吸器治療的人數節節上升,但經口插管對口咽結構及功能的損傷,易造成吞嚥及進食上的困難,文獻已指出長期經口插管病患(氣管插管 48小時者)於拔管後有吞嚥困難之盛行率高達62%,亟需早期介入且國內缺乏相關介入研究,故本前驅研究旨於發展一個針對氣管內管拔管後中老年病患的口腔吞嚥護理方案,並評估其實際執行之可行性與介入成效。 研究方法: 本研究採雙組前後測(before-and-after intervention)研究設計,自2015年1月10日至10月10日,以台北市某醫學中心內科加護病房插管 48小時且成功拔除氣管內管之中老年病患( 50歲)為實驗組對象(n=55),曾有吞嚥困難、中風等神經疾病、口咽結構異常、接受氣切、絕對隔離之病患則予以排除。另外,控制組則由計畫主持人陳佳慧教授之「長期經口插管後病患口腔、吞嚥及營養狀態之變化」研究中篩選出具相同收案條件之個案(n=127),其收案期間為2013年10月1日至2015年1月10日。所有個案於拔管後48小時內進行基準值前測,於拔管後第7天、第14天測量其口腔健康狀態、舌頭感覺(含輕觸覺、兩點辨識覺、形體辨識覺)、唾液分泌狀況、舌頭力量,並每日追蹤病患之吞嚥(使用台大三階段吞嚥篩檢)及進食狀態(使用功能性經口攝食量表)至拔管後21日。其中實驗組個案於進行基準值前測後即接受為期14天口腔吞嚥護理方案之介入,包含口腔潤濕清潔、唾液腺按摩、口腔運動及吞嚥進食衛教,控制組只接受一般病房常規之臨床照護。 研究結果: 病患對口腔吞嚥護理方案之配合度佳,吞嚥進食衛教可達100%,其次為口腔清潔潤濕按摩的97%及口腔運動的67%。實際操作時,平均需花15.6分鐘,研究期間並無造成任何傷害或吸入性危險,安全性佳,故整體而言此方案具可行性。 經過初步地分析,實驗組病患於氣管內管拔管後一週的舌頭力量、唾液分泌、舌頭兩點辨識覺及口腔健康狀況上的成效顯著優於控制組,而拔管後兩週口腔健康狀況上的成效仍顯著優於控制組。另外,兩組在通過台大三階段吞嚥篩檢的天數並無顯著差異,但在恢復至「完全無限制地由口進食」狀態的天數上,在將氣管插管天數控制後,實驗組顯著低於控制組(13.5 7.8天vs. 16.7 6.6天,調整後p值=0.027)。 結論: 口腔吞嚥護理方案對於長期氣管插管病患拔管後部分吞嚥及進食狀態指標有正面效果,但並非所有指標皆有成效。未來還要仰賴增加收案數、進行特定變項之配對及控制後進一步研究方可證實此方案成效。 | zh_TW |
dc.description.abstract | Background & Objectives:
With rapid growth of medical technology, patients receiving oral endotracheal intubation have increased. Although endotracheal intubation is a life-sustaining procedure, its presence can deteriorate the structure and function of oropharynx, which may contribute to the difficulties in swallowing and subsequent oral intake. Estimated 62% of patients who had been intubated 48 hours will experience post-extubation dysphagia. Intervention is needed but studies are lacking in this regard. Thus, the objective of this pilot trial is to develop and test an Oral Swallowing Care Program (OSCP) for patients aged 50 years and older following prolonged endotracheal intubation. Method: A before-and-after with historical control design was used. We enrolled subjects who were over 50 years old and had prolonged ( 48 hours) oral endotracheal intubation as experimental group (n=55) from six medical intensive care units at a medical center in Taipei, Taiwan from January 10th, 2015 to October 10th, 2015. Subjects with prior swallowing difficulties, oropharyngeal structural deficiency, neurological disease, tracheostomy, and absolute quarantine were excluded. Subjects in the control group (n=127) were screened by the same criteria from October 1st, 2013 to January 10th, 2015. All participants were assessed within 48 hours post-extubation for the baseline data. Outcome were assessed on 7th and 14th day post-extubation including tongue strength, salivary secretion, tongue sensation (light touch, two-point discrimination and stereognosis) and oral health status. In addition, Three-Step Swallowing Screen (3-SSS) and Functional Oral Intake Scale (FOIS) were assessed daily 21 days following extubation. OSCP comprised of daily oral care (moisturizing and cleansing of oral cavity and salivary gland massage), oral motor exercise, and intake education was provided to the experimental group for two weeks after extubation while the control group received usual care. Results: Participants positively perceived the OSCP with good compliance rates up to 100% for intake education, 97% for daily oral care, and 67% for oral motor exercise. The average time spent for daily OSCP was 15.6 minutes, suggesting that OSCP was clinically feasible. Preliminary analyses indicated that participants received OSCP had better scores (tongue strength, salivary secretion, two-point discrimination, oral health status) by 7th days post-extubation, compared to the controls. By 14th days post-extubation, oral health status was still significantly better for participants received OSCP. Days to pass 3-SSS were not differed between groups. However, days to reach total oral diet with no restrictions were significantly reduced for participants received OSCP (13.5 days vs. 16.7 days, adjusted p=0.027) after adjusted for length of intubation. Conclusion: The OSCP demonstrated benefits on some of the variables but not all. However, given the feasibility of OSCP for post-extubated patients, future studies and analyses are required to verify the effects of OSCP. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T13:43:24Z (GMT). No. of bitstreams: 1 ntu-104-R01426007-1.pdf: 1817026 bytes, checksum: e7103626e63f40b96226abd41d6a364b (MD5) Previous issue date: 2015 | en |
dc.description.tableofcontents | 致謝……………………………………………………………………………………. .i
中文摘要………………………………………………………………………….….…iii 英文摘要…………………………………………………………………………….….v 第一章 緒論 …………………………………………………………………………..1 第一節 研究背景、動機與重要性………………………………………………1 第二節 研究問題與假設…………………………………………………………3 第三節 研究目的…………………………………………………………………4 第四節 名詞界定…………………………………………………………………5 第二章 文獻查證 ……………………………………………………………………6 第一節 正常的吞嚥過程 …………………………………………………………6 第二節 長期經口插管對口咽與吞嚥功能的損傷. ………………………………8 第三節 氣管插管拔管後吞嚥困難的介入措施…………………………………12 第四節 研究概念架構………………………………………………………….…19 第三章 研究方法 …………………………………………………………………….21 第一節 研究設計…………………………………………………………….……21 第二節 研究對象與場所…………………………………………………….……22 第三節 研究工具…………………………………………………………….……23 第四節 資料收集流程…………………………….………………………………28 第五節 介入措施…………………………….……………………………………30 第六節資料處理與分析………..…………………………………………….……35 第七節研究對象權益保護………..………………………………………….……36 第四章 研究結果…………………………………………………………………….37 第一節 研究對象之基本屬性…………………………………………………..39 第二節 口腔吞嚥護理方案之可行性…………………………………………..42 第三節 口腔吞嚥護理方案對舌頭肌肉力量、舌頭感覺、唾液分泌及口腔健康 狀況之成效…………………….……………………………………….43 第四節 口腔吞嚥護理方案對吞嚥功能及由口進食恢復之成效………….….50. 第五章 討論…………………………………………………………………………..55 第一節 口腔吞嚥護理方案之可行性…………………………………………...55 第二節 口腔吞嚥護理方案之改善成效………………………………………...57. 第三節 口腔吞嚥護理方案於臨床的應用………………………………………58 第六章 結論與建議………………………………………………………………...…60 第一節 結論……………………………………………………….………………60 第二節 研究限制與建議………………………………………………………….61 參考文獻 …………………………………………………………………………..…63 中文部分…………………………………………………………………………..…63 英文部分…………………………………………………………………………..…66 附錄…………………………………………………………………………………...72 附錄一、基本資料表………………………………………………………..….…72 附錄二、口腔評估指引...…………………………………………………………74 附錄三、台大三階段吞嚥篩檢…………………..…………………………….…75 附錄四、功能性經口攝食量表 ……………………………………………….…76 | |
dc.language.iso | zh-TW | |
dc.title | 口腔吞嚥護理方案於長期氣管插管病患拔管後吞嚥及經口進食狀態之成效 | zh_TW |
dc.title | Effects of an Oral Swallowing Care Program on Swallowing and Oral Intake Status in Patients Following Prolonged Endotracheal Intubation | en |
dc.type | Thesis | |
dc.date.schoolyear | 104-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 王亭貴(Tyng-Guey Wang),蕭自佑(Tzu-Yu Hsiao),古世基(Shih-Chi Ku) | |
dc.subject.keyword | 口腔吞嚥護理方案,長期插管,拔管後吞嚥困難,吞嚥狀態,進食狀態, | zh_TW |
dc.subject.keyword | oral swallowing care program,prolonged intubation,post-extubation dysphagia,swallowing status,oral intake status, | en |
dc.relation.page | 76 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2015-12-18 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 護理學研究所 | zh_TW |
顯示於系所單位: | 護理學系所 |
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