吞嚥困難居家個案之營養照護經驗

Nutrition Care Experience of a Dysphagia Home Patient

本個案為一居家照顧之68歲重度失能男性，因腦中風導致吞嚥困難（dysphagia)而以鼻胃管灌食，案妻為主要照顧者，對於個案身體功能的恢復期待甚高，尤其希望能夠盡快恢復由口進食，因此將部分管灌配方經口餵食。經臺北市長照中心轉介，營養師於2012年9月至2013年6月間，對案家進行共三次家訪及兩次電訪，因觀察到個案由口進食時有嗆咳反應，並不建議家屬繼續增加或維持將食物由口餵食，但隨著個案自行拔管，家屬便順勢將食物全量由口餵食，可能因而導致個案後來的再發疾病。本報告以回溯方式檢討個案之營養照護過程，討論居家營養師對吞嚥困難個案的飲食建議，以及在缺乏團隊資源的情況下，應更積極協助案家尋求其他醫療專業的評估與介入。

This case is a 68-year-old home care of severely disabled men, resulting in dysphagia due to stroke with nasogastric tube feeding, his primary caregiver is his wife, she was very expected the case's body function can be restored especially hoping to resume as soon as possible by the oral intake, and therefore part of the tube feeding formula was eated from mouth. The Taipei city Long-term care Center referred this case to the Taipei Dietitian Association, and the dietitian conducted total of three times home visits and twice telephone interviews in September between 101 to 102 years in June, a, as observed in the case when eating choking response , so it was not suggested that the family will continue to increase or maintain the food from the mouth to feed, but because self-extubation cases, families put food to feed the entire population, this may result in the subsequent cases of disease recurrence. This report retrospectively review the case of nutrition care process, to discuss the cases of dysphagia home dietitian for diet advice, and in the absence of team resources, should be more actively assist the case home to seek other medical professional assessment and intervention.