嚥下造影検査後の早期呼吸器合併症についての検討

Early Pulmonary Complications after Videofluoroscopic Examination of Swallowing

要旨：摂食・嚥下機能の評価方法として，嚥下造影検査（VF）が広く用いられている．しかし発熱や肺炎等，VF後の呼吸器合併症について検討された報告は少ない．そこで今回，VF後に施行した胸部X線像上のバリウム残留位置の分布，および呼吸器合併症発症例の検討を行った．対象はVFおよび胸部X線撮影を行った198例である．誤嚥のない86例ではX線像上の残留を認めず，誤嚥のある112例中，40例でX線像上の残留を認めた．移乗能力および認知機能と，誤嚥の有無の間には有意な関係を認めなかった．発熱を認めた10例と，誤嚥の有無および残留の有無の間に有意な関連を認めなかった．1例が肺炎の診断基準を満たしたが，胃瘻からの経管内容の逆流が疑われた症例だった．以上よりVF後の早期呼吸器合併症は重篤なものは少なく，また呼吸器合併症評価のための胸部X線撮影の有用性は明らかでなかった．

Abstract : Videofluoroscopic examination of swallowing (VF) is widely used for evaluating swallowing function. However, pulmonary complications after VF are seldom evaluated. We checked residual barium sulfate on chest X-rays and early pulmonary complication after VF. One hundred and ninety-eight patients underwent VF and chest X-rays. Eighty-six patients who did not aspirate during VF had no residual barium on their chest X-rays. One hundred and twelve patients aspirated during VF, but only 40 of these patients showed residual barium on their chest X-rays. Ten patients had fever after VF, but no significant relationship was observed between fever and residual barium on chest X-rays or aspiration. Aspiration was not correlated with mobility or cognitive status. One case had pneumonia after VF, but VF did not seem to be the cause of the pneumonia. In conclusion, no severe early pulmonary complications after VF were observed. It is difficult to predict early pulmonary complications from chest X-rays.