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研究生:施惠薰
研究生(外文):SHIH, HUI-HSUN
論文名稱:鼻咽惡性腫瘤族群接受放射線治療後長期吞嚥障礙相關問題之探討
論文名稱(外文):Long-Term Effects of Radiotherapy on Swallowing Dysfunctions for Patients with Nasopharyngeal Carcinoma
指導教授:謝麗君謝麗君引用關係
指導教授(外文):HSIEH, LI-CHUN
口試委員:許家甄王瀛標
口試委員(外文):HSU, CHIA-TSENGWANG, YING-PIAO
口試日期:2022-07-28
學位類別:碩士
校院名稱:馬偕醫學院
系所名稱:聽力暨語言治療學系碩士班
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2022
畢業學年度:110
語文別:中文
論文頁數:82
中文關鍵詞:吞嚥障礙放射線治療長期影響鼻咽癌纖維內視鏡吞嚥檢查
外文關鍵詞:dysphagiafiberoptic endoscopic evaluation of swallowinglong-term side effectsnasopharyngeal cancerradiotherapy
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研究目的: 使用嗆入吸入量表(PAS)、咽部殘留量評分量表(YPR-SRS)去探討不同質地的食物對接受長期放射線治療後的鼻咽惡性腫瘤患者在吞嚥上的表現及相關性,另外也進行不同變項(疾病嚴重度分期、EAT-10、電療後時間、實際年齡、口乾程度、FOIS)及整體咽部殘留量之間的關聯性。
研究方法:透過對31位接受放射線治療後長期存活的鼻咽惡性腫瘤患者,以纖維內視鏡吞嚥檢查(FEES)及嗆入吸入量表、咽部殘留量評分量表對IDDSI第零級、第一級、第三級、第七級食物質地進行評估,並使用台灣版口乾量表及台灣版FOIS分別了解口乾及由口進食表現。
研究結果: (1)使用IDDSI第一級食物質地相較於IDDSI第零級、第三級更能同時了解嗆入吸入及咽部殘留量情形。(2)嗆入吸入量表與咽部殘留量評分量表有中度相關性,食物質地越稀薄(IDDSI第零級、IDDSI第一級)吸入嗆入時,在梨狀窩殘留量會越多,食物質地越濃稠(IDDSI第三級)吸入嗆入時,在會厭奚殘留量會越多。(3)電療後時長會影響整體咽部殘留量,而疾病嚴重度分期、實際年齡與整體咽部殘留量無關。(4)EAT-10、口乾程度與嗆入吸入及整體咽部殘留量有中低度相關,FOIS與嗆入吸入及整體咽部殘留量有中低度負相關;電療後時間與整體咽部殘留量有中低度相關。
研究結論及臨床應用:接受放射線治療五年以上的鼻咽惡性腫瘤族群有顯著嗆入吸入及咽部殘留風險,臨床上建議可優先使用IDDSI第一級食物進行評估,以纖維內視鏡吞嚥檢查搭配嗆入吸入量表、咽部殘留量評分量表為吞嚥評估中不可或缺的部分,自評量表EAT-10、口乾量表或FOIS也可反應長期電療影響的鼻咽癌患者吞嚥情形,電療後時間長短會影響吞嚥表現,因此需及早給予預防性的復健運動且持續關心並追蹤此族群的吞嚥狀況。
Objective: The incidence of nasopharyngeal carcinoma (NPC) in Taiwan is higher than the other countries, and most patients after radiotherapy suffer from dry mouth, muscle fibrosis and swallowing dysfunction. The major aim of the present study was to investigate the effects of different food and drink correlation on swallowing in NPC patients after long-term radiation therapy using the Penetration Aspiration Scale (PAS) and Yale Pharyngeal Residue Rating Scale (YPR-SRS). In addition, correlations between different variables (NPC staging, EAT-10, time after radiotherapy, age, degree of dry mouth, FOIS) and overall pharyngeal residual volume was also examined.
Methods: 31 NPC patients after radiotherapy for more than 5 years were evaluated by fiberoptic endoscopy and swallowing scale (PAS, YPR-SRS) with different viscosity of fluid( IDDSI level 0,1,3). Besides, EAT-10, PAS, YPR-SRS, FOIS , Xerostomia Questionnaire were recorded to explore swallowing deficits and correlation between different tools and scales.
Results: (1) Compared with IDDSI grade 0 and grade 3, the use of IDDSI first-level food texture could better indicate the dysphagia of NPC patients. (2) There was a moderate correlation between PAS and YPR-SRS. The more residues in the piriform sinus and the thicker the food and drink consistencies (IDDSI level 0,1), the more residues in the epiglottis (IDDSI level 3). (3) The time after radiotherapy affected the overall pharyngeal residual volume.(4) EAT-10, the degree of dry mouth was moderately to lowly correlated with PAS and overall pharyngeal residual volume, FOIS was moderately to lowly negatively correlated with PAS and overall pharyngeal residual volume; time after radiotherapy was low to moderately associated with overall pharyngeal residual volume.
Conclusion and clinical application: The risk of penetration, aspiration and pharyngeal residual increased in the group of NPC who have received radiotherapy for more than 5 years. FEES together with PAS and YPR-SRS were an integral part of the swallowing assessment. EAT-10, Xerostomia Questionnaire and FOIS were appropriate tools to detect swallow disorders. The length of time after radiotherapy affected the swallowing performance, therefore, preventive rehabilitation exercises should be given as early as possible, and the swallowing status of these patients should be monitored and followed up continuously.
摘  要 i
ABSTRACT ii
表  索  引 iv
圖  索  引 vi
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第二章 文獻探討 3
第一節 鼻咽癌之流行病學、臨床分期與治療 3
第二節 鼻咽癌患者吞嚥表現 6
第三節 吞嚥相關量表 9
第四節 進食評估問卷-10(EAT-10)於頭頸癌族群之表現 12
第五節 咽部殘留量評分量表(YPR-SRS)之相關研究 14
第六節 口乾症及口乾量表 15
第七節 吞嚥儀器檢查 17
第三章 研究方法 18
第一節 研究問題 18
第二節 研究假設 18
第三節 研究設計 19
第四節 研究流程 20
第五節 研究步驟 21
第六節 研究工具 23
第四章 研究結果 27
第一節人口學特性之描述性統計 27
第二節IDDSI分級食物質地及吞嚥相關量表之描述性分析 29
第三節獨立樣本檢定分析 36
第四節相關分析 42
第五章討論 58
第一節鼻咽癌人口學特性之描述性分析 58
第二節吞嚥相關量表及IDDSI分級食物質地之描述性分析 60
第三節IDDSI分級食物之吸入嗆入與咽部殘留情形之相關性 62
第四節EAT-10、疾病嚴重度分期、電療後時間、實際年齡、口乾程度、FOIS與吸入嗆入情形、咽部殘留量之探討 63
第六章結論與建議 66
第一節研究結論 66
第二節研究限制 68
第三節研究建議 69
參考資料 70
中文部分 70
英文部分 71
附錄 78
附錄一 台灣中文版口乾量表授權同意書 78
附錄二 中文版EAT-10、台灣版功能性由口進食量表授權同意書 78
附錄三 人體試驗委員會同意書 79

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