脳卒中後の嚥下障害と栄養障害の関連

神奈川NSTMLにも投稿した内容ですが、こちらにも記載します。
脳卒中後の嚥下障害と栄養障害のレビュー論文がありましたので、紹介します。

一部のみ訳します。8つの研究で、脳卒中患者に栄養障害を認める割合は8.2%から49.0%、嚥下障害を認める割合は24.3%から52.6%。
5つの研究は脳卒中発症後7日以内、3つの研究は急性期以降のリハの時期（回復期）。
嚥下障害患者では、嚥下障害を認めない患者より、栄養障害の割合がオッズ比で2.425倍（95％信頼区間1.264-4.649,
p<0.008）統計学的に有意に高い。
サブグループ解析では、回復期では、嚥下障害患者に栄養障害の割合が高い（オッズ2.445倍、95％信頼区間1.009-5.925,
p<0.048）、発症後7日以内では統計学的有意差なし（オッズ2.401倍、95％信頼区間0.918-6.277, p<0.074）。

私の論文解釈：サブグループ解析で統計学的有意差がなくても臨床的有意差は認める。急性期でも回復期でも、嚥下障害患者には栄養障害を認める可能性オッズ比で2.4倍が高く、脳卒中患者では嚥下障害と栄養障害に関連を認める。

私の考え：嚥下だけでも栄養だけでも不十分で、臨床では両者を同時に評価して介入することが望ましい。脳卒中が重症であるほど、嚥下障害と栄養障害の両者を認めやすい可能性がある。脳卒中以外の患者（特に高齢者、誤嚥性肺炎の一部、廃用など、筋萎縮による嚥下障害）では、嚥下障害と栄養障害の関連がより強い可能性がある。

A review of the relationship between dysphagia and malnutrition
following stroke.
Foley NC, Martin RE, Salter KL, Teasell RW.
Lawson Health Research Institute, Parkwood Hospital, London, Ontario,
Canada. J Rehabil Med. 2009 Sep;41(9):707-13.

OBJECTIVE: To clarify the relationship between malnutrition and
dysphagia following stroke. DESIGN: Systematic review. METHODS: All
published trials that had examined both the swallowing ability and
nutritional status of subjects following stroke were identified.
Pooled analyses were performed to establish whether the odds of being
malnourished were increased given the presence of dysphagia. RESULTS:
Eight studies were identified. The presence of malnutrition and
dysphagia ranged from 8.2% to 49.0% and 24.3% to 52.6%, respectively.
Five of the included trials were conducted within the first 7 days
following stroke, while 3 were conducted during the rehabilitation
phase. The overall odds of being malnourished were higher among
subjects who were dysphagic compared with subjects with intact
swallowing (odds ratio: 2.425; 95% confidence interval: 1.264-4.649, p
< 0.008). In subgroup analysis, the odds of malnutrition were
significantly increased during the rehabilitation stage (odds ratio:
2.445; 95% confidence interval: 1.009-5.925, p < 0.048), but not
during the first 7 days of hospital admission (odds ratio: 2.401; 95%
confidence interval: 0.918-6.277, p < 0.074). CONCLUSION: In a
systematic review including the results from 8 studies, the odds of
being malnourished were increased given the presence of dysphagia
following stroke.