統合失調症患者に対する摂食時の看護観察は、摂食・嚥下機能評価と関連するのか

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統合失調症患者は、一般集団と比較して咀嚼能力が低いことや、薬の副作用による摂食行動不良が窒息事故と関連するといわれてきた。そのため、本疾患対象者への摂食時観察の重要性は以前から認識されてはいた。しかし、精神科看護師は、摂食・嚥下機能評価を生かした上で摂食時の観察を行っているのか、その実態は明らかにされてはいなかった。そこで、本研究は、観察の必要ありと判断された患者は、摂食・嚥下機能評価と関連があるのかを明らかにした。対象は、調査期間に研究に協力が得られた精神科病院入院中の統合失調症患者97名(40〜76歳:平均年齢60.12±8.6歳)だった。摂食・嚥下障害の質問紙調査、現在歯数や義歯の適合状況、歯みがきの回数調査、および反復唾液嚥下テスト(repetitive saliva swallowing test:RSST)や摂食時動作の観察を行った。その結果、20本以上の現在歯数の割合は50歳代が約50%で、この割合は一般人口の60歳後半の割合に最も近く、歯を磨かない割合も一般人口のそれよりも上回っていた。義歯保持者のうちで食べにくさを自覚する人の80%は義歯の不適合があり、統合失調症患者の口腔保健に関するセルフケアの低さが明らかとなった。摂食時の観察に対する看護上の判断は、摂食動作の問題と関連があったが、摂食・嚥下機能の問題には関連しなかった。この結果から、予期せぬ誤嚥や窒息事故が生じる可能性は今後も充分に予測された。摂食・嚥下機能スクリーニングを臨床に普及させ、摂食時の観察にこれらを反映させることが急務の課題であった。As compared with the general population, the lower mastication capacity as well as the poorer eating behavior probably due to a drug-induced side effect has been suggested to relate to a suffocated accident in patients with schizophrenia. Although the importance of nursing observation during eating in patients with schizophrenia was already recognized even in former times, its actual state, i.e., whether or not the psychiatric nurses observe their patients during eating by making the best use of the previously evaluated result on the patient's eating/swallowing functions, is not yet elucidated. The present study was thus performed in order to elucidate a possible relation between the indicated necessity of nursing observation and the evaluated eating and swallowing functions in patients with schizophrenia. The subjects were 97 patients with schizophrenia who were hospitalized in psychiatric hospitals and accepted to cooperate for the present study after adequate explanation. The age of patient ranged from 40 to 76 yrs and averaged 60.12 ± 8.6 yrs old. In these subjects, a questionnaire survey was performed concerning their potential risk of dysphagia, the present number of remained teeth, the denture fitting status and the frequency of tooth brushing in parallel with the execution of repetitive saliva swallowing test (RSST) and the observation on the patient's eating behaviors. As a result, the proportion of patient who has 20 or more remained teeth was 50% in the fifties, the value of which closely approximate to that in the sixties in the general population. The rate of non-brushing habit was also higher in patients with schizophrenia as compared with the general population. Among denture-wearing individuals, about 80% of those patients who become conscious of difficulty in eating were revealed to have a poor denture fitting status, indicating a relatively low level of self-care management for the oral health in patient with schizophrenia. It was also evident that the decided necessity of nursing observation during eating relates to the disturbed eating behaviors but not to the disturbed eating and swallowing functions. From the result of this study, it was sufficiently estimated that an unexpected false swallowing and/or suffocated accident may occur in the future as well. Therefore, it seemed to be a pressing need to make screening test of eating and swallowing functions prevailed in the clinical practice and to reflect the results in the subsequent nursing observation during eating.
日本赤十字九州国際看護大学の論文
2009-09-30

統合失調症患者に対する摂食時の看護観察は、摂食・嚥下機能評価と関連するのか

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日本赤十字九州国際看護大学 | 論文

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