経管栄養患者に対する三環系抗うつ薬投与による唾液分泌抑制効果の検討

Abstract

In patients being fed with a nasogastric tube (NGT) or gastrostomy tube, over secretion of saliva can cause aspiration pneumonia. Tricyclic antidepressants (TCA), which has an anti-cholinergic effect, is used at our hospital for patients with hypersalivation. The efficacy and safety in the suppression of saliva secretion with the use of tricyclic antidepressants, such as amitriptyline (AMT), were examined. From January 2018 to May 2019, patients who had hypersalivation, were suffering from aspiration pneumonia and who were supported by the nutrition support team (NST), were administered AMT. Comparison of the frequency of saliva suctioning and the course of disease, before and after AMT use, was carried out in 6 patients. A significant decrease in the frequency of suctioning was observed in all 6 patients after 1 week of AMT administration. Four patients had NGT and 3 of them were able to have gastrostomy with continuous AMT use. Four patients were discharged from the hospital to their home or a nursing home. Aspiration pneumonia occurred in only 1 patient and AMT dosage was decreased in 1 patient due to dry mouth. Medical accidents, such as self-removal of NGT or IV tubing, due to delirium caused by antidepressants are of deep concern. Initial and continuous use of TCA must be taken into careful consideration. Adverse reactions to TCA are relatively mild in most cases. Early detection and treatment and evaluation of the balance between a patient’s physical burden and the effectiveness of inhibiting saliva secretion are very important.