統合失調症における嚥下障害―CP換算量，年齢および日常生活自立度との関連

Dysphagia among Schizophrenic Patients as Related to CP Equivalent Dose, Age, and Activity of Daily Living

抄録

　統合失調症の嚥下障害者174症例を対象として，嚥下障害の程度と服用抗精神病薬のchlorpromazine(CP)換算量，年齢および日常生活自立度(ADL)との関連を検索した。ADLの評価は，「障害老人の日常生活自立度(寝たきり度)判定基準」に準じた。また，嚥下障害の程度は藤島のGrade分類により評価し，重症(Grade 1～3)，中等度(Grade 4～6)，軽症(Grade 7～9)に分類した。

　嚥下機能評価時のCP換算量の平均は重症症例：346mg，中等度症例：390mg，軽症症例：551mgであり，軽症症例でCP換算量が高い傾向が認められたが，重症，中等度および軽症症例の間でCP換算量に有意差はなかった。また，80歳以上では嚥下障害のGradeの平均が5.0と，59歳以下(6.4)と比較して有意(p＜0.05)に低下(嚥下障害が重症化)していたが，59歳以下，60歳代，70歳代の各年代間でGradeに有意差は認められなかった。

　他方，ADLの低下に伴い嚥下障害のGradeは低下し，Gradeの平均はランクB(5.5)およびランクC(4.3)ではランクJ(7.2)と比較して有意(J vs. B：p＜0.005，J vs. C：p＜0.0001)に低かった。

　以上の結果より，統合失調症の嚥下障害の程度はADLと密接に関連するものの，嚥下機能評価時のCP換算量とは関連しないことが示唆された。

　This study involved 174 schizophrenic patients diagnosed with dysphagia and examined the relationships between the grade of dysphagia and the chlorpromazine equivalent (CP) dose, age, and activity of daily living (ADL). The ADL was classified into ranks J, A, B, and C according to the ADL classification established by the Japanese Ministry of Health, Labour and Welfare. The grade of dysphagia was classified into severe (Grade 1-3), moderate (Grade 4-6), and mild (Grade 7-9) according to Fujishima's classification.

　At the time of the swallowing function evalution, the mean CP equivalent doses among the severe, moderate, and mild dysphagia cases were 346mg, 390mg, and 551mg, respectively, and there was no significant relationship between the mean CP equivalent dose and the grade of dysphagia.

　Whereas the grade of dysphagia in the cases over 79 years (5.0) was significantly lower (p＜0.05) than that of those below 60 years (6.4), there was no obvious relationship between age and the grade of dysphagia. In contrast, the swallowing function became impaired as ADL decreased, and the mean grade of dysphagia was significantly lower in the in the ranks B (5.5, p＜0.05) and C (4.3, p＜0.005) cases than in the rank J cases (7.3).

　These results indicate that there is no significant relationship between the CP equivalent dose and the swallowing function even though this function is significantly related to the ADL among schizophrenic patients.