急性期脳卒中の退院先と嚥下障害

急性期脳卒中患者の短期予後に対する嚥下障害の影響に関する論文を紹介します。埼玉医科大学国際医療センターの前島先生の論文です。素晴らしいです。

Maeshima S, Osawa A, Miyazaki Y, Seki Y, Miura C, Tazawa Y, Tanahashi N. Influence of dysphagia on short-term outcome in patients with acute stroke. Am J Phys Med Rehabil. 2011 Apr;90(4):316-20.

急性期病院から自宅退院した脳卒中患者の90％が常食を経口摂取していました。一方、嚥下調整食の経口摂取や経管栄養の脳卒中患者の大半は転院しました。これより他の要因の考慮も必要ですが、急性期脳卒中における嚥下障害の臨床評価は、直接自宅退院できるかどうかを決定するのに重要です。

常食を経口摂取できないことは、脳卒中全般の重症度や嚥下リハの質など他の因子の影響を大きく受けますが、早期経口摂取や早期摂食・嚥下リハを推進して、早期3食経口摂取だけでなく早期常食経口摂取を目標として達成できれば、より多くの急性期脳卒中患者が直接自宅退院できるようになるかもしれません。

Abstract
OBJECTIVE: The aim of this study was to determine whether dysphagia present at initial swallowing evaluation is associated with the type of diet eaten at the time of discharge and the location to which the patient is transferred after discharge.

DESIGN: A total of 409 newly diagnosed acute stroke patients were studied.

RESULTS: After hospital discharge, 140 patients returned home, 250 were transferred to another hospital for rehabilitation, and 7 were admitted to a nursing home. Twelve patients died. A total of 205 patients were on a regular diet, 96 were receiving a dysphagia diet, and 96 were on enteral feeding at discharge. A total of 90.7% (127/140) of patients who were discharged home were on a regular diet. Most of the patients on a dysphagia diet or enteral feeding could not return home. The scores of the functional independence measure were higher in the patients who returned to their homes than in other groups.

CONCLUSIONS: Although it is necessary to indicate other factors, such as the physical status to establish better rehabilitation networks, clinical assessment of swallowing in acute stroke is very important to determine whether the patients can go home directly.