摂食嚥下時の誤嚥・咽頭残留アセスメントに関する看護ケアガイドライン

Japanese Clinical Practice Guidelines for Aspiration and Pharyngeal Residual Assessment during Eating and Swallowing for Nursing Care

要旨

　目的：本資料は，日本看護科学学会より公開した「看護ケアのための摂食嚥下時の誤嚥・咽頭残留アセスメントに関する診療ガイドライン」の要約版である．

　方法：本診療ガイドラインは，「Minds診療ガイドライン作成マニュアル2017」に従い，研究エビデンスと益と害のバランス，患者の価値観などに基づき作成された．

　結果：身体診査技術を用いた系統的アセスメント，反復唾液嚥下テスト，改訂水飲みテスト，フードテスト，頸部聴診法，超音波診断装置による嚥下観察，内視鏡による嚥下観察に関するクリニカルクエスチョンをもとに，10の推奨が作成された．8つの推奨はGRADE（Grading of Recommendations Assessment, Development and Evaluation）2Cとして評価され，残りの2つはGRADEなしとして評価された．

　結論：看護ケアのためのアセスメントに焦点を当て，最新の知見を盛り込んだ信頼性の高い診療ガイドラインが作成された．本資料は要約版であり，臨床実践への活用が期待される．

　Aim: The purpose of this clinical practice guideline is to provide and recommend methods of assessing aspiration and pharyngeal residue during eating and swallowing and methods of selecting and implementing nursing care for adults in order to prevent the development of aspiration pneumonia through early and appropriate management of oropharyngeal dysphagia.

　Methods: In April 2018, Japan Academy of Nursing Science established the Supervisory Committee in Nursing Care Development/Standardization Committee to develop clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care. This clinical practice guideline was developed in accordance with Minds Manual for Guideline Development 2017, with the aim of providing a specific pathway for nurses to determine the policy for selecting management for oropharyngeal dysphagia based on research evidence and multifaceted factors such as the balance of benefits and harms and patients' values.

　Results: Based on 10 clinical questions related to assessment by physical assessment, the Repetitive Saliva Swallowing Test, Modified Water Swallowing Test, Food Test, cervical auscultation, observation using an ultrasound diagnostic device, and an endoscope, 10 recommendations were developed. Eight recommendations were evaluated as GRADE 2C, and the other two were evaluated as no GRADE.

　Conclusion: We were able to produce the first reliable clinical practice guideline from an academic nursing organization that focuses on assessment for nursing care and incorporates the latest findings.