アブストラクト
Japanese
| Title | 誤嚥性肺炎の既往を伴う高齢者の嚥下内視鏡検査所見について |
|---|---|
| Subtitle | 原著 |
| Authors | 横関彩佳1), 森田倫正1,2), 小浜尚也3), 永見慎輔3), 福永真哉3) |
| Authors (kana) | |
| Organization | 1)倉敷紀念病院リハビリテーション部, 2)倉敷紀念病院耳鼻咽喉科, 3)川崎医療福祉大学リハビリテーション学部言語聴覚療法学科 |
| Journal | 日本摂食嚥下リハビリテーション学会雑誌 |
| Volume | 26 |
| Number | 3 |
| Page | 173-179 |
| Year/Month | 2022 / 12 |
| Article | 原著 |
| Publisher | 日本摂食嚥下リハビリテーション学会 |
| Abstract | 「要旨」【目的】高齢者の嚥下障害の有無は誤嚥性肺炎と密接に関連し, その発症リスクを増加させることが指摘されている. そのため, 早期から嚥下機能の評価や対応を行うことが望ましい. 当院では, 嚥下障害が疑われた症例に対し, 主に嚥下内視鏡検査 (VE) を用いて評価を行っている. VE検査は簡便に実施することができ, 質の高い評価が可能であるものの, 本邦ではVE検査所見から誤嚥性肺炎発症との関連因子を検討した報告は少なく, 十分な研究が行われていない. そこで本研究では, 臨床現場でしばしば遭遇する高齢者の誤嚥性肺炎に焦点をあて, VE検査所見から嚥下動態を解析することで, 誤嚥性肺炎の発症に関連する因子を明らかにすることを目的とした. 【対象と方法】当院にて嚥下障害が疑われVE検査を受けた65歳以上の高齢者254例を対象とし, 1カ月以内に誤嚥性肺炎発症の既往がある群 (54例) と非発症群 (200例) で, VE検査における嚥下動態について統計学的に比較検定を行い, 関連性を検討した. 加えて, 検査時の姿勢, 藤島の摂食嚥下能力グレード (FILS), 栄養状態について統計学的に比較検討を行った. 【結果】誤嚥性肺炎既往群と非既往群の群間比較では, 男性, 高年齢, 神経変性疾患の有無, 検査時の姿勢, FILSで有意差を認めた (p<0.05). VE検査所見では, 声門閉鎖の程度, 梨状陥凹唾液貯留, 早期咽頭流入, 水分の梨状陥凹残留で有意差を認めた (p<0.05). 誤嚥性肺炎の既往の有無を目的変数, 2群間の比較で有意差を認めたVE検査項目を説明変数としたロジスティック回帰分析では, 早期咽頭流入が抽出された. 【結論】本研究の結果, 誤嚥性肺炎の既往がある高齢者のVE検査所見から, 誤嚥性肺炎の既往に関連する因子として早期咽頭流入に着目する必要があると考えられた. |
| Practice | 医療技術 |
| Keywords | 誤嚥性肺炎, 高齢者, VE検査, 早期咽頭流入, aspiration pneumonia, elderly persons, videoendoscopic examination, premature spillage into the pharynx |
English
| Title | Videoendoscopic Examination Findings in Elderly Patients with a History of Aspiration Pneumonia |
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| Subtitle | |
| Authors | Ayaka YOKOZEKI1), Norimasa MORITA1,2), Naoya OBAMA3), Shinsuke NAGAMI3), Shinya HUKUNAGA3) |
| Authors (kana) | |
| Organization | 1)Department of Rehabilitation, Kurashiki Kinen Hospital, 2)Department of Otolaryngology, Kurashiki Kinen Hospital, 3)Department of Speech-Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare |
| Journal | The Japanese Journal of Dysphagia Rehabilitation |
| Volume | 26 |
| Number | 3 |
| Page | 173-179 |
| Year/Month | 2022 / 12 |
| Article | Original article |
| Publisher | The Japanese Society of Dysphagia Rehabilitation |
| Abstract | [Abstract] [Background and Purpose] : The presence of dysphagia is closely related to aspiration pneumonia and has been shown to increase the risk of developing aspiration pneumonia. In our hospital, we mainly perform videoendoscopic (VE) examination for observing swallowing dynamics of patients who are suspected of dysphagia. VE examination is a simple and useful method for diagnosing dysphagia. However, there are few reports that have examined factors associated with the onset of aspiration pneumonia based on VE findings, and sufficient research has not been performed. The purpose of this study was to elucidate the factors associated with aspiration pneumonia by analyzing swallowing dynamics obtained from VE findings, focusing on older patients because cases of aspiration pneumonia are frequently encountered among the elderly in clinical sites. [Methods] : The present study included 254 elderly patients aged 65 years or older, who underwent VE for suspected dysphagia. Of these, 54 and 200 patients had a history of aspiration pneumonia and no history of aspiration pneumonia, respectively. The VE findings were compared between the two groups. In addition, statistical comparison tests were performed for posture during examination, Fujishima dysphagia scale (FILS), and nutritional status. [Results] : A comparison between the groups with and without previous aspiration pneumonia showed significant differences in male, older age, presence of neurological disease, posture during examination, and FILS (p<0.05). The VE findings showed significant differences in the degree of glottis closure, salivary retention in the pyriform sinus, premature spillage into the pharynx and post-swallow pyriform sinus pooling of liquid (p<0.05). In a logistic regression analysis using the presence or absence of a history of aspiration pneumonia as the objective variable and the VE items that showed significant differences between the two groups as explanatory variables, early pharyngeal inflow was extracted. [Conclusions] : Premature spillage into the pharynx on VE was shown to be a highly relevant factor in patients with a history of aspiration pneumonia. |
| Practice | Medical technology |
| Keywords | aspiration pneumonia, elderly persons, videoendoscopic examination, premature spillage into the pharynx |
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