気管内挿管抜管後の嚥下障害について

Abstract

気管内挿管抜管後は嚥下障害が生じやすいことが報告されている．今回気管内挿管抜管後に嚥下障害を認めた 69 例を対象に， 嚥下機能の経過についてカルテから後方視的に調査し，経口摂取が困難であった要因を検討した．結果は 69 例中退院時までに 経口摂取可能だったのは 44 例であった．経口摂取困難だった 25 例は脳血管疾患が多く，既往に誤嚥性肺炎などがあった．ま た気管切開例と再挿管例の割合も高かった．退院時までに経口摂取が困難だった要因として，原疾患や既往による嚥下障害が 重度であったこと，気管孔閉鎖が困難であったこと，再挿管による粘膜損傷などが関係していることが考えられた．

Dysphagia is said to occur easily after extubation of the endotracheal intubation. We retrospectively surveyed the path of dys phagia in 69 cases of dysphagia occurring after the endotracheal intubation was extubated. We examined the cause of the aspira tion pneumonia. Forty-four of the 69 patients were able to consume food orally by the time of discharge from hospital. Many of the 25 patients with dysphagia had cerebrovascular diseases, and had a history of aspiration pneumonia. The reason why oral con sumption was still difficult at the time of discharge, was due to the degree of preexisting dysphagia. The percentage of intubation and re-intubation cases was also high. The damage to the mucosa at the time of intubation and difficulty in closing the stoma was also considered to be related to the dysphagia.