回復期リハビリテーション病棟における気管切開患者の転帰

The Outcome of Patients with Tracheostomy in a Convalescence Rehabilitation Ward Setting

要旨：気管切開を有する患者の回復期リハビリテーション病棟での経過について調査を行った．4年間に当院を退院した患者3,179名のうち，入院時に気管切開を有した78名（全入院患者の2.5％）を対象とした．46名（59％）は入院中にカニューレ抜去・気管切開孔閉鎖に至った．抜去までの平均日数は35日であった．78名全員が入院時に実用的経口摂取を行っていなかったのに対し，退院時には51名（65％）が何らかの形で経口摂取可能となり，うち38名は3食経口摂取に至った．意識障害や身体機能障害が重度の症例でカニューレ抜去が困難なことが多かったが，意識障害があっても，ADL全介助レベルでも抜去できた症例があった．急性期に気管切開が必要でも，その後長期的に必要とは限らず，カニューレ変更・気管切開孔閉鎖の可否を検討することや，気管切開があっても適切な評価をもとに経口摂取訓練を進めることは，回復期リハビリテーションの重要な役割の1つと考える．

Abstract : The purpose of this study is to investigate the outcome of patients with tracheostomy in a convalescence rehabilitation ward. Of 3,179 patients who were discharged from our hospital in 4 years, 78 subjects who had tracheostomy tubes at admission were included in the study. Forty-six of those patients (59％) were decannulated during hospitalization. The number of days required for decannulation was 35 days on average. While all of the 78 subjects had no oral intake at admission, upon discharge, 51 subjects (65％) were able to take some kind of oral intake, and 38 of those were able to take oral nutrition fully. Additionally, those patients with consciousness disorders or severe physical impairments often had difficulty with decannulation. However, some cases with severe consciousness disorders or patients who were totally dependent for their physical care were successfully decannulated. Patients who require tracheostomy at the acute stage should be further evaluated for its necessity during the recovery phase. Some of the important aspects to consider in convalescence rehabilitation include evaluating the possibility of changing the type of tracheostomy tubes, examining the possibility of removing the tracheostomy tubes altogether, and performing dysphagia rehabilitation.