Standardalization of clinical evaluation and risk management in comprehensive medical treatment and nursing for patients with dysphagia

本研究旨在为吞咽困难患者建立综合的医疗护理、临床评估和安全执行，以防止误吸。制定标准化的医疗方法和护理方法，包括广泛使用的程序和护理系统，是非常重要的。首先，我们制定了荧光显像（VF）的评价表和评价标准，有效地提高了VF的评分间信度。此外，VF发生的时间与患者的疾病有关，15%的口服喂养患者有VF观察到的误吸。当VF与重复性唾液吞咽测试（RSST）有很大关系时，所使用的测试食物的质地，而姿势调节和颈部旋转与误吸有关。两者都被认为是防止误吸的基本技术。此外，视频内窥镜检查会厌形状与误吸有关。虽然无声吸痰常被床边评估所忽视，但咳嗽试验对于观察中、重度吸痰患者是一种准确的筛查试验。它是非侵入性的、有用的、准确的床边评估工具。此外，还建立了病区监护工作的记录文件和临床合作路径等。该途径用于口咽癌切除术后吞咽困难患者的治疗，缩短了从手术到培训的时间，实现了早期出院。吞咽训练被发明了。这是专家讨论的基本培训方法，不仅适用于患者，也适用于相对独立的老年人。全国调查显示，护士吞咽困难的患病率为13.6% ~ 25.1%，对护士吞咽困难的研究需求较大。护理方案和系统干预的效果验证还不够充分，是未来的研究对象。

This research aims to establish the comprehensive medical treatment and nursing, which is considered clinical evaluation and safety perfoming for dysphagic patients to prevent aspiration. It is very important to develop the standardized methods of medical approach and nursing including the program and care system for broad use. First of all, we made evaluation sheet and criteria of videofluorography (VF), that was effective to improve inter-rator reliability of VF. Moreover, the timing of VF wasdepend on the diseases of patients, and 15% of the patients with oral feeding had aspiration that was observed by VF. The texture of test food that was used when VF was considerably related to RSST (repetitive saliva deglutition test) and postural modulation and neck rotation was related to aspiration. Both were considered to essential technique for preventing aspiration. Moreover, the shape of epiglottis checked by videoendoscopy (VE) was related to aspiration. Although silent aspiration was usually overlooked by bedside evaluation, cough test was accurate screening test to looking at patients with middle or much amount of aspiration. It was a noninvasive, useful, and accurate tool as bedside evaluation. Moreover, the record papers and a clinical pathway to cooperate in order to carry out a ward care smoothly etc. were created. This pathway was used for the management of dysphagic patient after resection of oropharyngeal cancer, days from operation to training was shortening and early discharge were attained. Gulp training was invented. That was essential training method discussed by specialists and able to be used not only the patients but also comparative independent elderly people. Prevalence of dysphagia was 13.6% to 25.1% by national investigation, so the study needs for dysphagia of the nurse were great. The effect verification of a care program and the intervention in a system were not enough, and they are future subjects.