当院における脳卒中患者の嚥下障害改善に影響を与える要因の検証—重回帰分析を使用して

Verification of factors influencing improvement of dysphagia in stroke patients at our hospital: Using multiple regression analysis

　本研究では，嚥下能力改善に影響を与える要因について検証した．対象は当院回復期リハビリテーション病棟入棟の脳血管疾患により嚥下障害を呈した107名のうち，入院時藤島式嚥下グレード（以下，嚥下Gr）7〜10の患者および入院期間30日未満を除外した47名とした．退院時嚥下Grから入院時嚥下Grを減じたものを嚥下Gr改善度とし，嚥下Gr改善度を従属変数，年齢，疾患名，入院時GNRI（Geriatric Nutritional Risk Index），入院時FIM運動項目合計点，入院時FIM認知項目合計点を独立変数としてステップワイズ重回帰分析を実施した．回帰分析の結果，入院時GNRIとFIM運動項目合計点が抽出され（回帰係数0.31，0.49），入院期間を投入しても同じ項目が抽出された（p＜0.05，R²＝0.316）．

　本研究の結果より，嚥下能力改善には，入院時の栄養状態や身体機能が関与することが示唆された．

　In this study, we investigated factors that affect improvement in swallowing ability. The subjects were 107 patients who had swallowing disorder due to cerebrovascular disease and were admitted to the recovery-phase rehabilitation ward in our hospitals. Patients whose Fujishima's Grade for Feeding and Swallowing Ability(SG) was 7-10 at the time of admission and those who had been hospitalized for less than 30 days were excluded, leaving 47 patients who were included in the study. The degree of SG improvement was determined by subtracting SG at hospital admission from SG at discharge. We performed stepwise multiple regression analysis with the degree of SG improvement as the dependent variable, and age, disease name, Geriatric Nutritional Risk Index(GNRI) at hospitalization, FIM motor subscore and FIM cognitive subscore at hospitalization as independent variables. As a result of regression analysis, the GNRI and FIM motor subscore at hospitalization were extracted. The same items were extracted even when the hospitalization period was entered(p＜0.05, β=0.31, 0.49, R²=0.316). The results suggest that improvement in swallowing ability is related to improvement of nutritional condition and physical function.