名古屋記念病院における嚥下機能評価導入前後の誤嚥性肺炎患者の在院日数に関する後方視的調査研究

抄録

To evaluate the usefulness of the screening test of the two-step bed side examination of swallowing function, we retrospectively analyzed 145 patients who were admitted to Nagoya Memorial Hospital with aspiration pneumonia between April 2015 and March 2016. The screening of swallowing function was performed by a multidisciplinary team in October, 2015. Then, the duration of hospital stay along with the patients' characteristics, such as age, sex, and underlying diseases, the severity of pneumonia defined by the A-DROP system, laboratory data (white blood cell count, C-reactive protein level, and albumin level), results of sputum bacterial cultures, and antibiotic therapy, were compared in patients between before (group A, n = 65) and after introducing the screening test of swallowing function (group B, n = 80). Aspiration risks were categorized into 4 grades using a standard sequential screening system; high, moderate, low, and none. Initiation of the screening test of swallowing function significantly reduced the number of inpatients whose duration of stay was more than 3 weeks (group A, 45/ 65 [69.2％] versus group B, 42/ 80 [52.5％]; P < 0.05, Fisher's exact test). This finding can mainly be attributed to the proper assessment of the aspiration risk, which enabled determination of the food form and the time to start oral ingestion without any incidents or accidents, and can facilitate the rapid intervention by a speech therapist and expert nurse.