The Effectiveness of Flat Lateral Position Method for Patients with Severe Dysphagia Patient in Home Medical Care

2010年８月～2013年３月までに訪問診療依頼があった167件のうち、重度嚥下障害と診断を受け、非経口摂取であった60歳以上の在宅療養患者19名（藤島摂食・嚥下能力グレード１）に対して嚥下評価と食事姿勢の指導を行った。このうち初診時の嚥下内視鏡検査において、経口摂取が可能（藤島摂食・嚥下能力グレード５以上）と評価された者は19名中10名であった。食事姿勢に関しては座位２名、30度仰臥位１名、完全側臥位７名であった。従来の誤嚥予防指導では安全な経口摂取が困難であると評価される対象者に完全側臥位法を導入することは経口摂取獲得に有効であることが示唆された。対象者は経口摂取獲得後も代替栄養を継続とした。経口摂取のみでは不足する水分量及び栄養量を適切な代替栄養で補い全身状態を整えることが「食べることを楽しむ」QOL向上の背景となることも併せて示唆された。Among 167 requests for home medical care between August 2010 and March 2013, we provided evaluation of swallowing function and eating posture guidance to 19 home care patients aged 60 years or older who had been diagnosed with severe dysphagia and were taking parenteral food（ Fujishima dysphagia scale FILS 1）. Of these 19 patients, 10 were assessed as being able to take food orally（ Fujishima dysphagia scale FILS ≧5 ） during the initial video endoscopic examination of swallowing. In terms of eating posture, two patients were in the sitting position, one in the 30-degree supine position, and seven in the flat lateral lying position. Our results suggest that the introduction of the flat lateral position is effective in helping patients who have difficulty with safe oral intake with conventional aspiration prevention instruction to obtain oral intake. The subject continued to receive alternative nutrition after acquiring oral intake. It was also suggested that supplementing the amount of water and nutrients that are insufficient for oral intake alone with appropriate alternative nutrition and improving the general condition of the patient can be the background for improving quality of life（ QOL）, which is the ability to enjoy eating.