急性期頸髄損傷例における嚥下障害の発症機序と機能訓練

Dysphagia due to C4-5 Spinal Cord Injury and Its Mechanism―Report of a Case

I．はじめに

　1930年代に嚥下障害に対して機能訓練が行われた報告があるが^1），嚥下障害の機能訓練が普及し始めたのは1980年以降である。今日では嚥下障害に対する機能訓練の有効性に疑いはないが，機能訓練の効果発現機序や適応は明らかでないものが多い。

　最近われわれは，嚥下障害を合併した若年者の頸髄損傷を治療する機会を得て，頸椎前方固定術を受けた急性期脊髄損傷にみられた嚥下障害の発症機序と，嚥下障害に対する機能訓練の効果発現機序について若干の知見を得たので報告する。

　A 25-year-old man with C_4-5 spinal cord injury who underwent anterior cervical fusion had disphagia after the operation.

　Dysphagia was resulted from pain after the operation,but not from the cranial nerve disorders.

　The respiratory dysfunction,placement of a naso-tracheal tube,tracheostomy and the placement of a tracheal tube,which resulted in difficulty of expectoration of pooled materials in the hypopharynx and the upper trachea,made his dysphagia more serious. The serious dysphagia consequently required the placement of a tracheal tube. Cutting this vicious circle by the medical management and the physical therapy for respiratory dysfunction,we could succeed in his oral intake. Excluding the factors influencing negatively to dysphagia is important.