臺灣博碩士論文加值系統

大多數全喉切除者會出現嗅覺功能減退的情形。嗅覺功能的缺失通常會伴隨味覺功能減退，可能對吞嚥過程產生負面的影響。目前直接證實嗅覺與吞嚥之間相關性的文獻仍然不足，而且缺乏全喉切除後嗅覺復健與吞嚥生活品質之間的關聯性研究。本研究目的為探討嗅覺復健對於全喉切除者吞嚥生活品質的影響。
本研究受試者包含無喉復健組12名、無喉非復健組10名，以及正常組20名。無喉復健組受試者接受6週的鼻腔氣流導引法嗅覺復健介入；無喉非復健組則不提供任何介入。分析改良式Sniffin’ Sticks嗅覺辨識檢查、西北吞嚥障礙篩檢，以及M. D. Anderson吞嚥生活品質問卷結果，比較全喉切除受試者接受嗅覺復健前後的差異。
研究發現，全喉切除者的嗅覺功能表現顯著低於正常人 (p = .000)，排除全喉切除者的嗅覺障礙問題為老化因素導致。全喉切除者的西北吞嚥障礙篩檢 (p = .040)，以及吞嚥生活品質問卷得分亦顯著低於正常人 (p = .000)。無喉復健組接受嗅覺復健介入後，嗅覺功能評估結果 (p = .002)，以及吞嚥生活品質問卷得分 (p = .002) 呈現顯著提升，西北吞嚥障礙篩檢結果則未達顯著差異。無喉非復健組的前後測結果沒有發現任何評估項目呈現顯著差異。
鼻腔氣流導引法能夠顯著改善全喉切除者的嗅覺功能表現，以及吞嚥生活品質。全喉切除手術後的嗅覺障礙問題應當受到重視，並且應該將嗅覺復健含括於全喉切除手術後的整體復健計畫。

Most patients with total laryngectomy present with the condition of olfactory deterioration. The defect in olfactory function is always accompanied with decreased gustatory function, which may have a negative impact on swallowing processes. The literature to prove the connection between olfaction and swallowing is still lacking. No research on the relationship between olfactory rehabilitation and swallow quality-of-life after total laryngectomy has been conducted. The purpose of this research is to investigate the effects of olfactory rehabilitation on swallow quality-of-life in patients with total laryngectomy.
The research subjects included 12 individuals as total laryngectomic rehabilitative group (TL-R), 10 individuals as total laryngectomic non-rehabilitative group (TL-NR), and 20 normal subjects as typical group. The TL-R group received a 6-week-period of olfactory rehabilitation by nasal airflow-inducing maneuver (NAIM), while the TL-NR group didn’t have any intervention. The modified Sniffin’ Sticks odor identification test, the Northwestern Dysphagia Patient Check Sheet (NDPCS) and the M. D. Anderson Dysphagia Inventory (MDADI) were given to subjects in the TL-R and TL-NR group pre and post experiment, and to subjects in the typical group. The Mann-Whitney U test and Wilcoxon Signed Ranks test were used to compare the difference between pre and post olfactory rehabilitation in patients with total laryngectomy and in normal subjects.
The results revealed that the olfactory function in patients with total laryngectomy was significantly poorer (p = .000) than in normal subjects, which excluded the possibility that the olfactory impairment of patients with total laryngectomy was the result of aging. The scores of the NDPCS (p = .000) and the MDADI (p = .000) in patients with total laryngectomy were also significantly lower than in normal subjects. After olfactory rehabilitation, the TL-R group showed significantly improved scores on the olfactory function test (p = .002) and the swallow quality-of-life questionnaire (p = .002), whereas the NDPCS didn't show any significant difference before and after the rehabilitation. The TL-NR group didn’t showed any significant difference pre and post experiment in all assessments.
The NAIM can significantly improve the olfactory function and the swallow quality-of-life in patients with total laryngectomy. The NAIM is effective as a rehabilitation method in swallowing for patients with total laryngectomy.

誌 謝 I
中文摘要 II
英文摘要 III
目 錄 V
圖 目 錄 VIII
表 目 錄 IX
附錄目錄 XI
第一章 緒論 1
第一節 研究動機與研究目的 2
第二節 研究問題與假設 5
第二章 文獻探討 7
第一節 全喉切除對嗅覺的影響 7
第二節 嗅覺生理與病理 12
第三節 嗅覺與吞嚥的關係 19
第四節 嗅覺障礙與吞嚥生活品質 25
第五節 鼻腔氣流導引法 27
第三章 研究方法 33
第一節 研究架構 33
第二節 研究對象 34
第三節 研究工具 37
第四節 研究步驟 43
第五節 統計分析 51
第四章 研究結果 53
第一節 受試者基本資料 53
第二節 正常組及無喉組之嗅覺功能評估、吞嚥障礙篩檢，以及吞嚥障礙問卷結果分析 58
第三節 無喉復健組及無喉非復健組之嗅覺功能評估、吞嚥障礙篩檢，以及吞嚥障礙問卷結果分析 64
第四節 嗅覺復健成效分析 69
第五章 討論 83
第一節 全喉切除受試者相關變項探討 83
第二節 全喉切除者嗅覺障礙盛行率比較 84
第三節 鼻腔氣流導引法的嗅覺復健成效 87
第四節 臨床應用價值 98
第五節 研究限制 99
第六節 未來研究建議 100
第六章 結論 102
參考文獻 103

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