言語聴覚士のための呼吸ケアとリハビリテーション

Respiratory care and rehabilitation:Tutorial for speech-language-hearing therapists

　呼吸リハビリテーションはステートメントにおいて，原則としてチーム医療であり，急性期から回復期，そして維持期から終末期までシームレスな介入が重要と記されている．その主な対象である慢性閉塞性肺疾患（COPD）は，大多数の患者が未診断，未治療であることが重要である．一方，介護を必要とする高齢者，長期療養病床群もしくは介護施設に入所する患者が主たる対象者として発症する肺炎は医療・介護関連肺炎（NHCAP）と定義され，その多くは誤嚥性肺炎である．誤嚥性肺炎は，誤嚥の量や内容などの侵襲因子と活動量や栄養，免疫能などの抵抗因子のバランスが崩れたときに発症する．誤嚥性肺炎は繰り返すため，最も重要な介入は予防であり，その予防における言語聴覚士の役割は大きい．

　近年，地域医療において，活躍する言語聴覚士が増えている．その多くは，地域包括ケアシステムのもとでの仕事と思われる．しかし，現行の地域包括ケアシステムは主に脳血管障害や運動器疾患などに関して論じられ，内部障害のシステム構築は甚だ遅れている．特に，在宅での介護量が増え，在宅生活が困難となる理由には，肺炎などの内部障害疾患の増悪が非常に多い．それを理解したうえでの，地域包括ケアシステムの運用が重要である．

　The joint position statement from the Japan Society for Respiratory Care and Rehabilitation, the Japanese Society for Respiratory Physical Therapy, and the Japanese Respiratory Society states that respiratory rehabilitation is, in principle, a team medical treatment, and that seamless intervention from the acute phase via the recovery phase and the maintenance phase to the end-of-life phase is important. It is important to note that the majority of patients with chronic obstructive pulmonary disease (COPD), which is the main target of this treatment, are undiagnosed and untreated. On the other hand, pneumonia that develops mainly in elderly people who require nursing care, patients in long-term care beds, or patients admitted to nursing facilities, is defined as healthcare-associated pneumonia (NHCAP), and most of these are aspiration pneumonia. Aspiration pneumonia develops when there is an imbalance between invasive factors such as the amount and content of aspiration and resistance factors such as activity level, nutrition, and immune function. Since aspiration pneumonia recurs, the most important intervention is prevention, and speech-language-hearing therapists play a major role in this prevention.

　In recent years, the number of speech-language-hearing therapists active in community medicine has been increasing. It is believed that many of them are working under the community-based comprehensive care system. However, the current community-based comprehensive care system is mainly discussed in terms of cerebrovascular disorders and musculoskeletal diseases, and the construction of a system for internal disorders is extremely delayed. In particular, the increase in the amount of care required at home and the difficulty of living at home are often due to the worsening of internal disorders such as pneumonia. It is important to operate a community-based comprehensive care system with this understanding.