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内容記述 |
摂食・嚥下障害者の栄養摂取方法と口腔内環境との関連を明らかにする目的で, 介護力強化病院および老人保健施設に入院・入居中の摂食・嚥下障害の疑いのある53名 (男性13名, 女性40名, 平均年齢78.1±11.3歳) 中, 義歯非使用者35名 (男性8名, 女性27名, 平均年齢76.9±12.0歳) を対象に, 本研究を行った。調査方法は, 日常生活状況, 口腔ケア, 摂食状況について, 担当の介護者, 看護婦 (士) に対して聞き取り調査を行った。口腔内診査, 機能評価, 口腔衛生状態については, 歯科医師・歯科衛生士が検査した。その結果, 以下の知見を得た。<BR>1) オーラルディスキネジアがある者は, 経口摂取者群で26名中3名 (11.5%), 経管栄養者群では9名中4名 (44.4%) であり, 経口摂取者群と経管栄養者群との間に, 5%の危険率で有意差が認められた。<BR>2) 開口量は, 30mm以上開口が可能な者は, 経口摂取者群では26名中20名 (76.9%), 経管栄養者群では9名中3名 (33.3%) であり, 経口摂取者群と経管栄養者群との問に, 5%の危険率で有意差が認められた。<BR>3) 舌炎がある者は, 経口摂取者群では26名中2名 (7.7%), 経管栄養者群では9名中5名 (55.6%) であり, 経口摂取者群と経管栄養者群との間に, 1%の危険率で有意差が認められた。<BR>4) 舌背部カンジダ菌陽性者は, 経口摂取者群では26名中22名 (84.6%), 経管栄養者群では9名中3名 (33.3%) であり, 経口摂取者群と経管栄養者群との問に, 1%の危険率で有意差が認められた。<BR>5) 栄養摂取方法を外的基準として数量化理論II類検定を行った結果, 舌炎が最も高い偏相関係数0.663を示した。 |
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内容記述 |
Oral feeding is extremely important to maintain the oral function for bedridden individuals. However, tube feeding is occasionally inevitable for dysphagic bedridden patients. Considerable differences are anticipated in oral-pharyngeal hygiene between oral and tube-fed individuals due to several factors. Unfortunately, there are no guidelines for oral health care per feeding method. The purpose of this study was to analyze the differences in oral-pharyngeal hygiene between oral and tube fed individuals to identify the necessary care factors for feeding guidelines.<BR>The subjects were 53 dysphagic individuals (13 males, 40 females, mean age 78). In this study, we selected 35 individuals (8 males, 27 females, mean age 77) who were non-denture wearers, of whom 9 were fed only by tube, and 26 by oral feeding alone (control). Evaluation methods included a questionnaire covering daily life activities, oral health care, and diet. Oral function and conditions were exemined clinically by dentists and a dental hygienist. Each patient was scored, and the results were analyzed by a Chi-Square test.<BR>The results obtained were as follows: <BR>1) Oral dyskinesia in oral fed individuals was significantly less than tube-fed individuals (p<0.05).<BR>2) Mouth opening width in oral-fed individuals was significantly greater than in tube fed individuals (p<0.01).<BR>3) Glotitis in oral fed individuals was significantly less than in tube fed individuals (p<0.01).<BR>4) C. albicans on the tongue surface in oral-fed individuals was more prominent than in tube-fed individuals (p<0.01).<BR>5) C. albicans on the palatine surface in oral-fed individuals was more prominent than in tube-fed individuals (p<0.05).<BR>6) Glotitis demonstrated the highest correlation to feeding methods by the Quantification Theory II.<BR>Based upon the results of the study, it is concluded that oral-fed individuals have factors that relate to the deterioration of intra-oral hygiene, while tube fed individuals have functional problems including mouth-opening difficulty. Therefore, appropriate oral health care is suggested per different feeding method.<BR>This study was supported by the Japanese Welfare Ministry as a part of its research into elderly health care in 1997. |
