中风病人之吞咽障碍-台东马偕纪念医院.PDF

中風病人之吞嚥障礙 台東馬偕神經內科 洪國華醫師 大綱 1.中風病人 與吞嚥障礙之相關性 2. 吞嚥之解剖生理學 3. 吞嚥困難之分類 4. 如何偵測吞嚥困難？ 5. 我們能做什麼？ 1.中風病人 與吞嚥障礙之相關性 中風後  27-50% dysphagia  43-54% aspiration  37% pneumonia Dysphagia  Greek dys (difficulty, disordered) and phagia (to eat)  Sensation that food is hindered in its passage from the mouth to the stomach  Most patients complain that food  “sticks,” “hangs up,” “stops,”  “just wont go down right” 吞嚥困難很常見  13~15% 急性病房病人有吞嚥困難  40~50% 安養機構病人有吞嚥困難 吞嚥困難可造成 …  Dehydration  Weight loss  Poor nutrition  Pneumonia  Chronic lung disease 證據顯示 有計畫的篩檢、診治中風病人之吞嚥困難， 可減少 肺炎發生率  長期使用胃管之機率  住院日 2.吞嚥之解剖生理學 Swallowing Anatomy Physiology of the Normal Swallow  4 Stages 1. Oral preparatory phase 2. Oral-propulsive phase 3. Pharyngeal phase 4. Esophageal phase Physiology of Swallowing: Oral Phase Pharyngeal Phase Physiology of Swallowing Pharyngeal and Esophageal Phase: Normal swallowing of a liquid bolus based on a videofluorographic recording Esophageal Anatomy  Muscular tube connecting the pharynx to the stomach  Esophagus begins where the inferior pharyngeal constrictor merges with the cricopharyngeus  Upper esophageal sphincter (UES)  18 to 26 cm in length  Lower esophageal sphincter (LES)  Thickened circular smooth muscle  40cm from incisors Esophageal Peristalsis  At rest  UES LES tonically contracted 