臺灣博碩士論文加值系統

老年人、中風病人、神經退化性疾病病人，如中風、失智、帕金森氏症、阿茲海默症，以及頭頸部癌、食道癌病人常有吞嚥困難的問題。研究顯示給予這群病人質地調整飲食可提高進食安全。全流質飲食是在室溫下為液態的食物，含少量纖維，且營養均衡，可使無法咀嚼、吞嚥固體食物之病患攝取到均衡的營養。南部某國立大學醫學院附設醫院營養部提供住院及出院病人訂購全流質餐，但多數出院病人因取餐不便而未繼續訂餐，中斷住院期間的飲食治療，使得營養不良的風險增加。若能開發冷凍全流質餐，讓病人可延續住院期間的飲食治療，將可降低營養不良的風險。

冷凍全流質餐在解凍及復熱的過程易遭受汙染，本研究目的在探討凍藏全流質食物的衛生安全，藉由微生物檢測來了解冷凍全流質食物在解凍及復熱時的微生物風險。檢測樣本經烹煮後放置於-18 ℃冷凍貯存7天和14天。微生物分析檢測樣本包括第7天及第14天的冷藏及微波解凍樣本，以及採用瓦斯及微波爐復熱並放置於室溫下0小時及1小時的復熱樣本。本研究將調查4種微生物菌數，包括總生菌數、大腸桿菌群、大腸桿菌、金黃色葡萄球菌。結果顯示冷凍貯存第7天及第14天全流質食物，不論是冷藏解凍或微波解凍的總生菌數均<103 CFU/g，大腸桿菌群均<10 CFU/g，大腸桿菌及金黃色葡萄球菌均呈陰性。全數的樣本皆符合衛生福利部公告的冷凍食品類衛生標準（總生菌數十萬以下、大腸桿菌群10以下、大腸桿菌呈陰性）。結果顯示冷凍全流質餐貯存14天是安全的。

第二個研究目的是希望透過滿意度及食用意願問卷調查了解病人食用現況及凍藏全流質餐商品化的可行性。全流質餐滿意度與食用意願調查結果發現，食用全流質餐的病人 52.4 %有咀嚼困難，28.6 %有吞嚥困難，47.6 %是經由營養師推薦食用全流質餐，各項滿意度以適口性95.3 %最高，香氣90.5 %次之，不滿意以菜單變化及溫度各佔9.5 %為最高，口味（鹹淡）4.8 %次之，整體滿意度非常滿意及滿意共佔95.3 %。

冷凍全流質食物經-18 ℃冷凍貯存7天及14天後，總生菌數、大腸桿菌群、大腸桿菌及金黃色葡萄球菌均符合衛生福利部公告冷凍食品衛生標準，因此可將南部某國立大學醫學院附設醫院營養部製作的冷凍全流質餐安全保存期限訂為14天。全流質餐滿意度及食用意願問卷調查結果顯示57 %的受訪者願意訂購冷凍全流質餐，因此未來可將冷凍全流質餐商品化，將能使病人延續醫院治療飲食，降低營養不良的風險。

Dysphagia is a common symptom in elderly people, and patients suffering from degenerative diseases such as stroke, dementia, Parkinson’s disease, and Alzheimer’s disease, and head and neck cancer. In these persons, food with a modified texture may facilitate safe oral intake. Full liquid diet is smooth liquids at room temperature. It contains fiber and variety of nutrients that can provide patient with chewing and swallowing difficult to get a balance diet. Southern National University Hospital, Department of Nutritional service provides inpatient and discharge patient a full liquid diet for nutrition therapy. However, most inpatients discontinue nutrition therapy when they discharge from our hospital, because the food is not convenient to take. Frozen full liquid diet could offer a convenient way to continue nutrition therapy and decrease malnutrition risk.

Contamination of frozen full liquid diet may occur during thawing and reheating. The main aim of this study was to investigate the microbiological risk points of reheating the frozen liquid diet. Tested liquid diet were cooked, and stored at -18 °C for 7 and 14 days. Samples for microbiological analysis were collected from refrigerator thawing, microwave thawing, stove reheating, microwave reheating and post recook placed room temperature 1 hour. We determined the aerobic plate count, Coliform, E.coli, and Staphylococcus aureus. At thaw and reheat, the mean aerobic plate counts for all samples were <103 CFU/g. The mean coliform counts for all samples were <10 CFU/g. The E.coli and Staphylococcus aureus counts for all samples were not detected. The results of this study show that the microbial quality of the frozen storage on 14 days of full liquid diet analysed were within published guidelines for safety.

The second aim of this study was to conduct a survey to understand the opinion of inpatients users towards the full liquid diet served to them and the willingness to use frozen full liquid diet. The current result showed that the inpatient users with chewing and swallowing dysfunction were 52.4% and 28.6%, respectively. Most (47.6%) of users get to know the full liquid diet product from the registered dietitian. Most (95.3%) of patients were satisfied with the palatability of the diet. Few (9.5%) of patients were discontent with the variety of recipe and food temperature. Overall satisfaction was 95.3%. More than 50% of patients were willing to purchase frozen full liquid diet.

Our study suggested that the safe frozen storage period for the full liquid diet was at least 14 days. Either ways of reheating operation was microbiologically safe. In addition, more than half (57%) of inpatient users were willing to purchase frozen full liquid diet when they were discharged from the hospital. Therefore, frozen full liquid diet prepared from mixed food could be commercialized and to provide a convenient nutrition regimen for outpatients to reduce risk of malnutrition.

封面 I
誌謝 II
中文摘要 III
英文摘要 VII
目次 VIII
圖次 IXX
表次 X
第一章前言 1
第二章文獻探討 3
第一節 吞嚥困難與營養不良 3
第二節 全流質飲食的應用 6
第三節 醫院供餐系統食品衛生與安全 11
第四節 冷凍食品安全 15
第五節 微生物測試片 17
第三章實驗目的 18
第四章材料與方法 19
實驗一 冷凍全流質食物之安全性評估 19
第一節 研究樣本與實驗材料 19
一、全流質食物 19
二、實驗材料 19
三、實驗設計 20
四、實驗流程 22
五、全流質飲食標準食譜 23
第二節 微生物檢測 24
一、樣本製作 24
二、微生物檢測流程 25
三、菌數分析 26
實驗二 全流質餐滿意度及食用意願問卷調查 28
一、方法 28
二、實驗設計 28
第三節 統計分析 29
第五章 結果與討論 30
第一節 微生物檢測 30
第二節 全流質餐滿意度及食用意願問卷調查 39
第六章 結論 52
第七章 參考文獻 53
附錄一 美國國家吞嚥困難飲食範例 63
附錄二 全流質餐滿意度及食用意願調查問卷 64
附錄三 全流質餐滿意度及食用意願調查問卷修正建議對照表 67

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