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

吞咽困难患者综合医疗护理临床评价及风险管理标准化

基本信息

批准号：
16390636
负责人：
CHIBA Yumi
金额：
$ 9.02万
依托单位：
Tokyo Medical and Dental University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
2004
资助国家：
日本
起止时间：
2004 至 2007
项目状态：
已结题

项目摘要

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.

本研究旨在建立综合医疗和护理，为吞咽困难患者预防误吸提供临床评估和安全性。开发标准化的医疗方法和护理方法（包括广泛使用的计划和护理系统）非常重要。首先，我们制定了视频荧光检查（VF）的评估表和标准，这有效地提高了VF的内部可靠性。此外，VF的时机取决于患者的疾病，经口喂养的患者中15%有VF观察到的误吸。 VF时使用的测试食物的质地与RSST（重复唾液吞咽测试）显着相关，并且姿势调节和颈部旋转与吸气相关。两者都被认为是防止误吸的基本技术。此外，通过视频内窥镜检查（VE）检查的会厌形状与误吸有关。虽然无声误吸通常被床边评估所忽视，但咳嗽测试对于观察中度或大量误吸的患者来说是准确的筛查测试。它是一种无创、有用且准确的床边评估工具。此外，为了顺利进行病房护理等，还制作了记录文件和临床协作路径等。该途径用于口咽癌切除术后吞咽困难患者的处理，缩短了从手术到训练的天数，并实现了早期出院。 Gulp 训练被发明了。这是专家们讨论过的基本训练方法，不仅可以用于患者，还可以用于相对独立的老年人。全国调查显示吞咽困难患病率为13.6%～25.1%，对护士吞咽困难的研究需求很大。护理方案的效果验证和系统的干预还不够，它们是未来的主题。