嚥下訓練開始時の状態と訓練の効果の関連について

Abstract

In this study, we investigated for a period of 8 years, 884 patients who underwent swallowing rehabilitation in our hospital, and evaluated the factors affecting resumption of oral intake of food. We found that the number of patients undergoing swallowing rehabilitation in our hospital increased over time. Of the included patients, 82.8% were ≥70 years of age and men were more frequent than women (p=0.004). At the end of the rehabilitation, 56.3% patients' main nutrition route was oral. Most (60.5%) patients required <30 days of rehabilitation. We evaluated correlation between the states of patients at starting point of swallowing rehabilitation and the result of the rehabilitation. The patients having a desire for eating were significantly more successful in regaining oral intake of food than those without the desire (p<0.001) and those with desire unknown (p<0.001). We classified the patients as per the Japan Coma Scale into four groups: alert, 1 digit, 2 digits, and 3 digits; the 3-digit group was significantly less successful in resumption of oral ingestion compared to all other groups (p<0.001). Based on the activities of daily living (ADL), we classified the patients into four groups: supine position, possible to semi-sitting group (get-up more than 30°), possible to sit-up group, and possible more than transferring by oneself group. It was proved that the supine position group was significantly less successful in regaining oral intake of food compared to all other groups (p<0.001). Multivariate analysis showed that the strongest correlation for regaining oral ingestion was desire for eating (p<0.001), followed by ADL and level of consciousness. In conclusion, we found that the number of patients undertaking swallowing rehabilitation in our hospital is increasing, and that factors such as desire for eating, ADL, and level of consciousness significantly influence the resumption of oral intake of food.