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BRAIN and NERVE Volume 59, Issue 5 （May 2007）

BRAIN and NERVE 59巻5号（2007年5月発行）

Japanese English

原著

脳卒中患者における誤嚥の有無と臨床症状の比較検討 A Comparison Study of Aspiration with Clinical Manifestions in Stroke Patients 前島伸一郎 ^1,2,4 , 大沢愛子 ^2,5 , 高城文彦 ^3,4 , 黒住司尾子 ² , 太田信子 ^1,2 , 熊倉勇美 ¹ Shinichiro Maeshima ^1,2,4 , Aiko Osawa ^2,5 , Fumihiko Takajo ^3,4 , Shioko Kurozumi ² , Nobuko Ota ^1,2 , Isami Kumakura ¹ ¹川崎医療福祉大学感覚矯正学科 ²川崎医科大学附属川崎病院リハビリテーション科 ³川崎医科大学附属川崎病院耳鼻咽喉科 ⁴現埼玉医科大学国際医療センター ⁵現 Rehabilitation Studies Unit, University of Sydney ¹Department of Sensory Science,Kawasaki University of Medical Welfare ²Department of Rehabilitation Medicine,Kawasaki Medical School,Kawasaki Hospital ³Department of Otolaryngology,Kawasaki Medical School,Kawasaki Hospital ⁴Saitama International Medical Center,Saitama Medical School ⁵Rehabilitation Studies Unit,University of Sydney キーワード： silent aspiration , stroke , videofluoroscopy Keyword: silent aspiration , stroke , videofluoroscopy pp.521-526

発行日 2007年5月1日 Published Date 2007/5/1

DOI https://doi.org/10.11477/mf.1416100046

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参考文献 Reference

はじめに

　不顕性誤嚥（silent aspiration：SA）は，咳やむせなどの徴候なしにみられる誤嚥であり，Amberson^1）によって最初に報告された。SAは嚥下障害の26.7～58.0％にみられるとされているが，疾患，年齢，時期，評価法などが報告者によって異なる^2－6）。近年，嚥下造影検査（videofluorography：VF）の普及によって，摂食・嚥下におけるSAを容易に発見できるようになった。また，最近は，VFや喉頭鏡検査（videoendoscopy：VE）を用いずに簡便に誤嚥リスクを判断できるベッドサイドでのスクリーニング検査が普及した^7，8）。

　摂食・嚥下に影響を及ぼす要因としては，年齢，覚醒レベル，認知機能，身体能力，肺炎の既往などが重視されている^9）。しかし，これらの臨床症状やスクリーニング検査とSAとの関係は明らかではない。本研究では，VFでSAを確認できた症例に対して，その要因についての検討を行った。

Abstract

　This study was investigated clinical factors for aspiration in stroke patients by videofluoroscopy (VF).　Subjects were 102 patients with strokes aged between 34 and 101 years including 72 males and 30 females and for whom VF was performed for swallowing difficulty or suspected swallowing difficulty.　They consisted of 64 patients with cerebral infarction,33 patients with cerebral hemorrhage,and 5 patients with subarachnoid hemorrhage.　Before VF,pharyngeal reflex,physical status,and cognitive function were evaluated as bedside clinical assessment.　As for swallowing evaluation at bedside,the repetitive saliva swallowing test (RSST) and water swallowing test were performed.　Aspiration was classified into aspiration with choking and silent aspiration (SA) by presence of a cough reflex.　As results,aspiration with foodstuffs on VF was found in 59 of 102 (57.8%) patients and SA was found in 44 of them (43.1%).　In patients with not only pharyngeal reflex but also cervical and maintaining a position stability,and those who were decreased in cognitive function,aspiration should always be supposed and the observation for eating behavior against aspiration should be needed.　We divided patients into three groups; no aspiration,SA and aspiration with choking.　Significant difference was observed between the groups in Mini-Mental State Examination,Barthel Index,and RSST.　Although in the water-swallowing test,swallowing was possible without choking,SA was observed on VF in most cases.　Therefore,in cases with serious disability and cognitive dysfunction with advanced age,RSST and water swallowing test should not be overestimated,it is worth conducting VF when aspiration is suspected from neurological assessment.