吞嚥困難者之備餐

Food Preparation for Patients with Dysphagia

吞嚥困難是指因身體機能、構造或心理上的原因，造成食物從口腔經過咽部進入胃的過程出現困難。常見於失智、中風、頭頸部手術、柏金森氏症、肌肉萎縮、年齡老化等患者。症狀包含出現嗆咳、流口水、食物須分多次吞食、無法順利進食等，亦可能引起吸入性肺炎、脫水或營養不良。由於吞嚥困難患者普遍存在口咽肌肉和舌頭力量不足的問題，因此無法將過硬或纖維過粗的食物有效咀嚼為適合吞嚥的食糰，而唾液分泌量不足也會增加咽部吞嚥太過乾燥或黏稠食糰的困難度，因此為吞嚥困難者準備飲食最大的重點在於挑選適當的食物質地，並根據不同程度的吞嚥障礙，調整供應食物的入口大小、軟硬度、濕潤度與濃稠度。此外，為了改善此類患者脫水與營養不良的情況，在飲食準備方面，會以體積小但營養密度高者為優先；在液體補充過程為避免造成嗆咳，亦會搭配天然或商業增稠劑來加強安全度。

Dysphagia is defined as difficulty in food passage from mouth through pharynx to stomach, which might result from functional, structural deficits or psychological causes. It is commonly found in dementia, stroke, head and neck surgery, Parkinson’s disease, muscular atrophy, and aging patients. The symptoms includes coughing, drooling of saliva, foods needed to be swallowed several times, and difficult swallowing. Furthermore, dysphagia could induce aspiration, dehydration or malnutrition. Due to tongue and oropharyngeal muscle weakness, hard solid or fibrous foods could not be masticated effectively to form suitable swallowable bolus. Insufficient saliva production enhances dryness of oropharyngeal area and difficulty of swallowing sticky foods. Therefore, The most important points of preparing foods for dysphagia are (1) choosing proper food texture, (2) according to stages of dysphagia, adjusting food particle size, hardness, moisture and thickness. In order to improve risk of patient's dehydration and malnutrition, preparing foods with small volume and high nutrient density is the first priority and adding natural or commercial thickeners to liquified foods to avoid of choking during liquid supplementation.