パーキンソニズム患者における肺炎発症後の経口摂取に関わる臨床的特徴

【目的】パーキンソニズム患者における肺炎発症後の経口摂取に関わる臨床的特徴について検討した．【方法】対象は肺炎で内科へ入院したパーキンソニズム患者136例とした．患者を経口群と非経口群に分類し，各種臨床項目を比較検討した．入院初期の重度嚥下障害患者の臨床経過についても調査をした．【結果】多変量解析の結果，退院時の経口摂取に関わる独立した項目は「入院初期の摂食嚥下障害重症度」と「入院前の日常生活自立度」であった．入院初期の重度嚥下障害患者に対して比較的早期から摂食嚥下リハビリテーションを開始していたが，神経内科医の入院中の関わりが少なく，全体でもパーキンソニズムの治療は約半数の患者にしか行われていなかった．【結論】一部のパーキンソニズム患者の摂食嚥下障害にはリハビリテーションに加えて投薬調整が重要とされており，今後は神経内科医と連携をして経口摂取の再獲得を目指す必要があると示唆された．

Objective: In this study, we examined clinical features predicting oral intake after onset of pneumonia in patients with Parkinsonism.
Methods: We enrolled 136 patients with Parkinsonism who were admitted to our hospital due to pneumonia. The patients were divided into an oral intake group and a non-oral intake group, and various clinical parameters were compared between the groups. We also investigated the clinical course of patients with severe dysphagia during the early stage of hospitalization.
Results: Multivariate analysis showed that independent clinical parameters related to oral intake at discharge were “severity of dysphagia during the early stage of hospitalization” and “degree of independence in daily living before hospitalization”. Dysphagia rehabilitation started at a relatively early stage in patients who had severe dysphagia during the early stage of hospitalization, but neurologists had little involvement during hospitalization and about half of the patients were treated for Parkinsonism.
Conclusion: Given that medication adjustment, as well as dysphagia rehabilitation, is important for treatment of dysphagia in some patients with Parkinsonism, collaboration with neurologists is necessary so that these patients can regain oral intake ability in the future.