Departmental Bulletin Paper 経皮内視鏡的胃瘻造設術(PEG) から経口摂取へ移行した1症例 ~摂食・嚥下リハビリテーションにおける作業療法の役割~
A case report showing the improvement of a patient who had undergone percutaneous endoscopic gastrostomy (PEG) to oral feeding ― The role of occupational therapy in the rehabilitation of dysphagia ―

飯坂, 唯  ,  黒沢, 智子  ,  安場, 恵  ,  久米, 愛  ,  中山, 加奈子  ,  加賀谷, 壮利  ,  東, 紘一郎  ,  久米, 裕  ,  ISAKA, Yui  ,  KUROSAWA, Satoko  ,  YASUBA, Megumi  ,  KUME, Ai  ,  NAKAYAMA, Kanako  ,  KAGAYA, Masatoshi  ,  HIGASHI, Koichiro  ,  KUME, Yu

23 ( 2 )  , pp.191 - 199 , 2015-10-31 , 秋田大学大学院医学系研究科保健学専攻
要介護高齢者における誤嚥性肺炎の発症率は高く, 平均寿命の延伸に伴い, 摂食嚥下障害を有した高齢者への介入がよりいっそう求められている. しかしながら, 回復期以降における非経口栄養から経口栄養へ向けた長期的な介入の報告は少ない. 本稿では, 大腿骨頸部骨折後に誤嚥性肺炎を繰り返したため経皮内視鏡的胃瘻造設術(PEG) を施行した事例に対する経口摂取に向けた介入を報告する. 廃用症候群の改善と摂食・嚥下障害の病態に応じた直接訓練(嚥下訓練) を組み合わせたリハビリテーションの介入によって, 本症例は3食経口摂取するまで改善した. したがって, 作業療法および理学療法の介入を含め, 摂食・嚥下機能の状態に合わせた継続的なリハビリテーションはより効果的であることが示唆された.
Elderly individuals who require care have a rate of aspiration-related pneumonia, and interventions forelderly individuals with dysphagia are more frequently required with the extension of the average humanlife span. However, there are few reports related to the long-term intervention of introducing non-oralfeeding to oral feeding after the convalescent stage. This paper reports the results of an intervention whichaimed to initiate oral ingestion in a patient with gastric fistula who repeatedly suffered from aspirationrelatedpneumonia after a fracture of the neck of his femur. The rehabilitative treatment, which involvesa combination of training (depending on the stage of the patient s ingestion/swallow function) to treatdisuse atrophy, improved the patient s condition to the point of complete oral feeding. Thus, our findingssuggest that the provision of continuous rehabilitative treatment in accordance with the ingestion/swallowfunctional status of patients with aspiration-related pneumonia is more effective when it is provided incombination with occupational therapy and physical therapy.

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