Establishment of scientific basis for objectively diagnosing oral intake in patients with aspiration pneumonia

2022 Fiscal Year Final Research Report

• Project/Area Number: 19K10207
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 57050:Prosthodontics-related
• Research Institution: Fujita Health University (2021-2022); Hiroshima University (2019-2020)
• Principal Investigator: Yoshida Mitsuyoshi 藤田医科大学, 医学部, 教授 (50284211)
• Co-Investigator(Kenkyū-buntansha): 丸山 真理子 広島大学, 病院(歯), 歯科診療医 (80613041)
• Project Period (FY): 2019-04-01 – 2023-03-31
• Keywords: 誤嚥性肺炎 / 嚥下造影検査 / 要介護高齢者

Outline of Final Research Achievements

The subjects of this study were 66 bedridden patients (35 males, 31 females, average age 92.3 years old) who were hospitalized for a long period of time in a long-term care medical facility. The attending physician requested a diagnosis regarding discontinuation of oral intake, and a videofluorographic examination was performed and we examined the most important points as criteria for discontinuation of oral intake. The results indicated that oral intake was diagnosed as discontinued when aspiration and delayed swallowing reflex were observed, regardless of age, gender, or background disease. It was clarified that if an appropriate examination is performed under an appropriate environmental setting, the dysphagia examination can serve as an objective criterion for judging whether oral intake should be discontinued.

Free Research Field

摂食嚥下リハビリテーション

Academic Significance and Societal Importance of the Research Achievements

日本呼吸器学会の成人肺炎診療ガイドラインでは、易反復性の誤嚥性肺炎のリスクがある場合は積極的な治療を行わず、個人の意思やQOLを考慮した治療やケアを実施することを提言している。しかしながら、どのような状態で経口摂取を継続すると誤嚥性肺炎を繰り返すことになるのかについては明らかとされていない。本研究結果は、このような終末期の患者では、年齢や性別、背景疾患に関わらず、誤嚥と嚥下反射遅延が認められる場合に、経口摂取を中止と診断した場合が多いことが示され、適切な環境設定のもと適切な検査を実施すれば、嚥下造影検査は、経口摂取中止をすべきかどうかの客観的な判断基準となりえることを明らかとした。