嚥下内視鏡検査後に直接訓練を開始した症例の食形態変化に寄与する因子

抄録

Direct training refers to training for oral intake using jelly or thickened water as a preliminary step to resumption of food intake. There is a wide range of patients with swallowing dysfunction, from mild cases who can begin to take food at an early stage, to severely impaired cases who need a long time to resume food intake. In this study, we investigated the relationship between the findings at the time of videoendoscopic evaluation of swallowing (VE) and the changes in the food intake patterns after VE in patients receiving direct training, and statistically analyzed the results.

We performed VE in 319 cases who were under the care of our hospital’s swallowing support team between July and December 2022. Of these cases, after excluding tracheostomy cases, we reviewed the data of 68 cases in which direct training by a speech therapist had been initiated. Statistical analysis was performed to determine the relationships between the findings at the time of VE (Hyodo score, level of consciousness, jelly residual in the epiglottic vallecura, and the serum albumin level) and the following three factors related to changes in the food intake pattern after VE: (1) food intake pattern at 1 week, (2) food intake pattern at discharge, and (3) rate of improvement of the food intake pattern.

The level of consciousness at the time of VE was weakly correlated with the food intake pattern at discharge (correlation r-value = 0.26; p-value = 0.03), the Hyodo score at the time of VE was weakly correlated with the food intake pattern at 1 week (r = 0.28, p = 0.02), and the presence of jelly residual in the epiglottic vallecula at the time of VE was weakly correlated with the food intake pattern at 1 week (r = 0.35. p = 0.003) and the rate of improvement of the food intake pattern (r = 0.39. p < 0.001). Although the serum albumin level at the time of VE was not directly associated with the changes in the food intake pattern following training, multiple regression analysis showed that the serum albumin level exerted a significant influence on the relationships between the other three factors and the changes in the food intake pattern following direct training. Thus, each of the four factors was involved in the changes of the food intake pattern following direct training.