誤嚥性肺炎患者に対する早期嚥下評価・嚥下訓練の影響

Effects of early dysphagia evaluation and dysphagia rehabilitation on patients with aspiration pneumonia

　誤嚥性肺炎患者の治療において，入院早期からの嚥下評価・嚥下訓練(以下，嚥下訓練)開始の効果は十分解明されていない．当院では，誤嚥性肺炎患者の経口摂取開始の遷延を防ぐことを目的に，入院早期からの言語聴覚士(以下，ST)による嚥下訓練に取り組んでいたが，2016年4月より土日祝日にもSTを病棟配置し早期開始を促進した．今回，嚥下訓練を行った誤嚥性肺炎患者260例を対象に，嚥下訓練開始までの期間と経口摂取確立(Food Intake LEVEL Scale 7以上)退院との関連の調査を行った．その結果，入院から嚥下訓練開始までの期間が長いと経口摂取確立退院は有意に少なかった(調整オッズ比0.776，95％信頼区間0.635〜0.949，p＝0.013)．誤嚥性肺炎患者に対しては，入院早期からの嚥下評価と嚥下訓練開始が望ましい．

　In the treatment of patients with aspiration pneumonia, the effects of early dysphagia evaluation and dysphagia rehabilitation have not been established. In our hospital, speech-language-hearing therapists (SLHTs) started dysphagia rehabilitation for patients with aspiration pneumonia immediately after their admission to minimize the delay of oral intake. From April 2016, SLHTs started dysphagia rehabilitation even on weekends and holidays and accelerated early rehabilitation. We investigated the relationship between the number of days it took to start dysphagia rehabilitation and successful achievement of total oral intake (Food Intake LEVEL Scale 7 and higher) at discharge in 260 patients with aspiration pneumonia. Results indicated that significantly fewer patients achieved total oral intake at discharge when the start of dysphagia rehabilitation was delayed (adjusted odds ratio: 0.776, 95% confidence interval 0.635-0.949, p=0.013). For patients with aspiration pneumonia, it is desirable to start dysphagia evaluation and dysphagia rehabilitation as early as possible after hospitalization.