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

本研究旨在建立一套综合性的医疗护理措施，作为吞咽困难患者预防误吸的临床评价和安全实施。因此，制定规范化的医疗护理方法，包括程序和护理体系，以广泛应用，是非常重要的。首先，制定了视频透视（VF）评价表和评价标准，有效地提高了VF评价者的可信度。此外，VF的出现时间与患者的疾病有关，15%的经口进食患者出现VF引起的误吸。当VF与RSST（重复性唾液吞咽试验）显著相关时，使用的试验食物质地，姿势调节和颈部旋转与抽吸相关。两者都被认为是预防误吸的基本技术。电视内镜检查会厌形态与误吸有关。虽然无症状性误吸常被床旁评估所忽略，但咳嗽试验对中、大量误吸患者是准确的筛选试验。是一种无创、实用、准确的床旁评估工具。此外，还创建了记录文件和临床路径，以便顺利开展病房护理等。将此路径应用于口咽癌切除术后吞咽困难患者的管理，缩短了从手术到培训的天数，并实现了早期出院。发明了吞咽训练。这是专家们讨论的基本训练方法，不仅适用于患者，也适用于相对独立的老年人。全国调查吞咽困难患病率为13.6%~ 25.1%，护士对吞咽困难的学习需求很大。对一个护理项目的效果验证和对一个系统的干预是不够的，这是未来的课题。

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.