嚥下障害リハビリテーション入門Ⅱ 嚥下障害の検査―VFとVEによる病態の理解

Dysphagia Testing with VF and VE : Understanding the Clinical Condition

はじめに

　日常の食事場面を観察することは，嚥下障害の評価の基本である．しかし，嚥下運動に伴う食塊の移動と口腔・咽頭・食道の嚥下関連器官の動きを体表から観察することは不可能である．そのため，機器を用いた検査が必要であり，日常診療場面で嚥下造影検査（videofluoroscopic examination of swallowing：以下VF）および嚥下内視鏡検査（videoendoscopic examination of swallowing：以下VE）が嚥下機能評価に用いられている．実際の食事場面と少し異なる状況下であるが，食塊の移動や嚥下関連器官の動き，誤嚥の有無などを評価でき，嚥下リハビリテーション（以下，リハ）に活用されている．VFとVEそれぞれの長所と短所を知り，それぞれを組み合わせて評価することで，多くの情報が得られ，嚥下障害の評価や治療に有用である．

Abstract : It is difficult to make dysphagia assessments in actual meal settings. Therefore, instrument-based evaluations are necessary, and videofluoroscopic examinations (VF) and video-endoscopic examinations (VE) of swallowing are typically performed for this purpose. Much information can be obtained by understanding the respective advantages and disadvantages of VF and VE and combining them for evaluations, making them useful for both assessment and treatment. Essentially, VF is contrast radiography using a fluoroscope. It uses test food containing a contrast agent that allows the flow of the food from the mouth to the pharynx and esophagus accompanying swallowing movements to be observed in real time to determine whether there is aspiration or food remaining in the pharynx. The images are taken mainly from the frontal and lateral views under fluoroscopy. VE is a test that involves direct fiberscopic observation of things such as glottal closure, saliva and secretions, and food boluses or other substances remaining in the pharynx. Assessment includes evaluation of vocal cord paralysis, redness and swelling of the arytenoid region, and whether there is saliva aspiration into the larynx. Next, the swallowing function is assessed using actual food. The body posture used in the test is the individual's regular posture when eating and a safe, proper posture with a low risk of aspiration. Today, VF and VE are essential tools for assessing and treating dysphagia. It is hoped that many practitioners will acquire the skills to administer and make use of these tests in the rehabilitation of patients with eating and swallowing disorders.