Journal Article 最近8年間に北海道大学病院歯科放射線科が対応した歯科異物の誤嚥および誤飲疑い症例の実態調査

金子, 正範  ,  山野, 茂  ,  塚原, 亜希子  ,  志摩, 朋香  ,  鈴鹿, 正顕  ,  入澤, 明子  ,  大森, 桂一  ,  箕輪, 和行

36 ( 2 )  , pp.72 - 81 , 2016-03 , 北海道歯学会
【目的】本研究の目的は,北海道大学病院における歯科異物の誤嚥と誤飲の発生傾向,対応および経過を調べ,対応の適切性と誤嚥と誤飲の防止策について検討することである. 【対象と方法】2006年から2013年までに歯科異物を誤嚥または誤飲した疑いがある患者43名が歯科放射線科のデータベースから選択された.本研究ではそれらの症例の診療録および放射線検査画像をもとに検討を行った. 【結果】43例中で誤飲が32例で発生していたが,全症例で誤嚥発生は無かった.誤飲例の性別は男性20例,女性12例であった.誤飲例の平均年齢は57.6才であり,最年少は8才,最年長は79才であった.誤飲例のうち60代以上の患者が59%を占めていた.嚥下機能に影響すると考えられる病歴や手術歴を有する者は10例(31%)であった. 誤飲物はメタルインレー7例,メタルクラウン6例,コア4例,歯科用切削・研磨バー4例,歯牙3例,その他が8例であった.修復物の試適時・装着時の誤飲が11例(34%)で最も多かった. 1例は画像検査前に異物を吐き出していた.内視鏡により異物が摘出されたのが3例で,うち,2例は食道から,1例は胃からであった.23例で異物排泄が確認されたが,5例では腹部エックス線撮影による排泄確認がなされなかった.排泄確認までの日数は平均8.8日,最短3日,最長51日であった.誤飲による体調不良の訴えはなかった. 【結論】歯科治療時には常に誤飲のリスクがあると考えられる.歯科異物の脱落を防ぐことが誤嚥・誤飲予防のために重要である.修復物の試適・装着時の誤飲が最も多かったことより,修復物にフロスを結紮や接着すること,ガーゼや歯科用吸引カニューレで咽頭を覆うこと,異物が直接咽頭に落ちにくい体位や頭位を患者にとらせることなどの対策を行うことが推奨される.高齢者や手術後および脳疾患などで嚥下機能に影響があると考えられる患者には既知の誤嚥・誤飲予防策を徹底的に行うことが重要である.誤飲後の対応は概ね良好だが,消化管に誤飲した後の排泄確認を徹底するべきであると考えられた.
Purpose : The purpose of this study is to consider the appropriateness of the correspondence and prevention measures against the accidental ingestion and aspiration of foreign dental objects. The trends of the occurrence, the correspondence, and the course after the incidents at Hokkaido University Hospital was investigated. Patients and methods : From the database in the Dental Radiology Department, 43 patients were selected who were suspected of accidental ingestion or aspiration of foreign dental objects from 2006 to 2013. The medical records and radiation image of those patients were assessed in this study. Results : In the 43 cases, accidental ingestion was observed in 32 patients, but accidental aspiration was not observed in all subjects. Of the accidental ingestion cases 20 were male and 12 were female. The average age within the 32 cases was 57.6, and ranged from 8 to 79 years of age. In the accidental ingestion cases, 59 percent of the patients were over 60. Ten cases (31%) had a medical and surgical history which is considered to affect the swallowing function.  Seven cases concerned the ingestion of the metal inlay, six cases of the metal crown, four cases of the core, four cases of the bur, three cases of ingesting teeth, and eight other cases. When mounting restorations, accidental ingestion was the most common with 11 cases (34%).  One case vomited-up the ingested foreign objects before the image inspection. Foreign objects of two cases were removed by endoscopic procedures from the esophagus and one case from the stomach. The excretion of foreign object was confirmed in 23 cases, however abdominal X-ray photographs had not been taken in 5 patients. The period of excretion ranged from 3 to 51 days, with an average of 8.8 days. No one complained of ill-health caused by the accidental ingestion. Conclusion : At the time of dental treatment there is always a risk of accidental aspiration or ingestion. It is important to consider the precaution of accidental ingestion and aspiration. Because accidental ingestion of the restorations before mount was the most common, preventions such as tying or adhesion of dental floss to restoration is recommended. Other recommendations include covering the pharynx with gauze or special dental suction cannula and proper positioning of the patient’s body and head to avoid foreign objects falling directly to the pharynx. It seems important to thoroughly ensure the prevention of accidental ingestion and aspiration in patients who are already known and affected in the swallowing function by old age, postoperative status and/or brain disease. It seemed that correspondence after the ingestion is generally acceptable, however, it is possible to make improvements in the confirmation of the excretion of the foreign objects in the gastrointestinal tract.

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