延髄外側急性期虚血性病変による嚥下障害の後方視的予後予測因子の検討—飲水評価の有用性

Retrospective study of prognostic factors of dysphagia due to acute lateral medullary ischemic lesion: Usefulness of water swallowing evaluation

　延髄外側病変による嚥下障害は，早期に改善するという報告の一方で長期間改善しないという報告があり，予後予測が困難である．そこで延髄外側虚血性病変による嚥下障害患者の機能予後予測因子を後方視的に検討した．対象は延髄外側虚血性病変に由来する嚥下障害患者10例とした．評価項目は年齢，意識障害の有無，軟口蓋麻痺の有無，嗄声の有無，咳嗽反射の有無，飲水評価とし，発症2か月以内の経管栄養離脱の比率について統計解析を行った．第14病日以内に飲水評価に合格した群(合格群)と合格できなかった群(不合格群)を比較すると，合格群は有意に経管栄養離脱の比率が高かった．その他の評価項目では有意差を認めなかった．延髄外側虚血性病変による嚥下障害において，急性期の飲水評価の合否が比較的早期に経口摂取に移行できることを予測する指標になる可能性が示唆された．

　It has been reported that dysphagia due to ischemic lesions in the lateral medulla oblongata improves early in the disease course in some cases but not in others. Thus, it is difficult to predict the prognosis of the dysphagia. In order to identify possible predictive factors, we retrospectively studied 10 patients with dysphagia due to ischemic lesions in the lateral medulla oblongata. The following factors were evaluated:age, presence of consciousness disturbance, presence of soft palate paralysis, presence of hoarseness, presence of cough reflex, and the water swallowing evaluation. The end-point was the necessity of tube-feeding 2 months after the stroke onset. The patients who passed the water swallowing evaluation within 2 weeks of the stroke onset left tube-feeding at a significantly higher rate than the patients who did not. No significant differences were observed in the other factors evaluated. We therefore suggest that in patients with dysphagia due to lateral medullary ischemic lesions, passing the water swallowing evaluation in the acute phase can be a predictor that the patient will leave tube-feeding at a relatively early stage.