背景：口腔清潔不佳及口咽肌肉不足，是引發中高齡肺炎病人住院的主因，其中 7 成診斷為吸入性肺炎。口腔清潔可有效降低口內細菌，改善口腔健康；另外也可藉由口腔運動改善口腔自淨的能力，強化吞嚥功能，兩者都可降低肺炎發生率。近年口腔管理開始被強調，針對健康老人同時提供口腔清潔及口腔運動顯示可改善口腔功能，然而，尚缺乏研究去評估急性住院期對於口腔健康以及口腔衰弱之有效性。
研究目的：探討中高齡肺炎病人於住院期間執行口腔管理前後其口腔健康、口腔衰弱之成效。
研究設計：本研究為前驅試驗，採實驗性研究設計，於南部某醫學中心內科病房進行收案，依區段隨機分派 (block randomization) 方式將收案對象分派至口腔照護組、口腔管理組及標準照護組。收案條件為：(1) 年齡大於或等於 50 歲；(2) 入院診斷為肺炎且有口腔衰弱病人；(3) 意識清楚 (格拉斯哥昏迷指數：15 分) 並可配合指令執行動作者。排除條件為：健康照護相關肺炎及頭頸部癌症、口腔結構異常病人。在入院第一天(基準值)及第 5 天後進行介入前後評估，評值工具包括口腔健康評估量表 (Oral Health Assessment Tool, OHAI)及七項口腔衰弱評估方法：舌苔覆蓋指數 (Tongue Coating Index, TCI)、唾液分泌量、牙齒數量、計算/pa/、/ta/和/ka/發聲次數、舌頭壓力，自評式咀嚼能力評估量表及重複吞嚥試驗 (Repetitive saliva swallowing test, RSST)。資料分析使用平均數、標準差、卡方檢定及單因子變異數分析進行。
結果：共收案46位，口腔照護組15位 (平均年齡 77.53 ± 11.38歲)，口腔管理組16位 (平均年齡79.0 ± 9.7歲) ，標準照護組15位 (平均年齡 76.40 ± 8.93歲) ，分析介入後的改善成效，則發現口腔管理組相較於其他兩組，可顯著提升口腔健康 (p= 0.032)，然而，在改善口腔衰弱情形則無呈現統計學上的差異，但在發出Pa/ Ka次數、吞嚥舌壓、唇壓及重複吞嚥測試等細項，口腔管理組相較於口腔照護組或標準護理組有較好的成效。
結論：合併有口腔衰弱的中高齡肺炎病人在住院期的短期口腔管理介入可顯著提升口腔健康，也能改善部分口腔衰弱機能，如發音次數、舌唇壓以及吞嚥能力等等，雖然介入口腔管理於提升口腔衰弱機能在統計學上顯著差異並不明顯，建議未來的研究可在增加收案個數及提升個案執行遵從度方向努力。

This study assessed the effects of oral management on oral health and oral frailty among middle-aged and elderly patients with pneumonia during hospitalization. Middle-aged and elderly hospitalized patients were randomized into three groups: oral care, oral management, and standard care groups. In addition, to receive customized oral care training, the oral management group also received oral exercises training such as tongue exercises and salivary gland massage thrice a day. We assessed oral health and oral frailty on admission (pretest) and 5 days after admission (posttest). Oral health was assessed using The Oral Health Assessment Tool (OHAT). Oral frailty was evaluated in terms of Tongue Coating Index (TCI) scores; oral dryness; the number of teeth; / Ta /, / Pa /, and /Ka/ vocalization frequencies; tongue pressure; masticatory ability; and swallowing ability. One-way analysis of variance (ANOVA) was used to analyze the differences between the pretests and posttests of oral health and oral frailty among the participants. The results indicated that the oral management intervention led to more favorable outcomes than did oral care or standard care, although oral frailty was not significantly affected. The small number of cases and low level of compliance may have affected the results; however, oral management interventions can benefit hospitalized middle-aged and elderly patients with pneumonia by improving oral health and oral frailty.

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