嚥下障害患者における咳嗽時最大呼気流速の継時的変化

Sequential changes in peak cough flow in patients with dysphagia

　摂食嚥下リハビリテーション(以下，嚥下リハ)を行った男性入院患者39名(平均年齢65±12歳)の介入中の咳嗽時最大呼気流速(Peak Cough Flow：PCF)値の変化を調べ，嚥下障害の重症度とPCF値との関係や誤嚥性肺炎発症者のPCF値について検討した．

　摂食・嚥下障害の臨床的重症度分類(Dysphagia Severity Scale：DSS)とPCF値との間に有意な正の相関を認めた．PCF値は，DSS改善例では嚥下リハ開始日と比べ終了日に有意に増加したが，DSS不変例では差がなかった．水分誤嚥と食物誤嚥のDSS改善例では，嚥下リハの段階が進むにつれてPCF値が増加した．1日当たりPCF値変化率は，直接訓練開始日−経管栄養離脱日間で一番大きいことより，直接訓練が進展し経口摂取が確立する時期に，咳嗽力も大きく向上する可能性が示唆された．誤嚥性肺炎患者の発症前直近のPCF値は140L/分と低値であることより，PCF値が低値の患者では，嚥下造影検査や嚥下内視鏡検査で安全な食物形態を確認するとともに，咳嗽力の向上後に直接訓練を開始するなどの対応が重要になると考えられた．

　The purpose of the present study was to investigate the sequential changes in Peak Cough Flow (PCF) in patients with dysphagia undergoing intervention. We tried to determine the relationship between PCF and the severity of dysphagia, and also to look at the PCF of patients with aspiration pneumonia. We measured the PCF of 39 male inpatients with an average age of 65 (SD 12) years who received swallowing training. There was a positive correlation between Dysphagia Severity Scale (DSS) and PCF. The PCF of the patients whose DSS score improved increased significantly, while the PCF of those whose DSS score showed no improvement did not change. At the Water Aspiration Level and Food Aspiration Level, the PCF of the patients whose DSS scores improved increased as their dysphagia rehabilitation advanced and their PCF change per day was the biggest between the day when patients started training with food (direct training) and the day when their feeding tubes were removed. The results suggest that the strength of cough greatly improves when the direct swallowing training progresses to the recovery of full oral intake. The precritical PCF of the patients with aspiration pneumonia was as low as 140L/min. It is recommended for patients with the low PCF level to start direct training after the appropriate meal form is evaluated by videofluorography or videoendoscopy and the strength of cough is improved.