Risk Factors for the Onset of Aspiration Pneumonia among Stroke Patients in the Recovery Stage in a Rehabilitation Hospital

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  • MIYAGAMI Mitsusuke
    Department of Rehabilitation and Neurosurgery, Takenozuka Nohsinnkei Rehabilitation Hospital
  • HOSHI Tatsuya
    Department of Rehabilitation, Takenozuka Nohsinnkei Rehabilitation Hospital
  • HUKUOKA Hiroyuki
    Department of Rehabilitation, Takenozuka Nohsinnkei Rehabilitation Hospital
  • TOHARA Haruka
    Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
  • ABE Kimiko
    Department of Dysphagia Rehabilitation, Nihon University School of Dentistry

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  • 回復期脳血管障害経管栄養例の誤嚥性肺炎の発症要因
  • カイフクキ ノウ ケッカン ショウガイケイカン エイヨウレイ ノ ゴエンセイ ハイエン ノ ハッショウ ヨウイン

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<p>　Objective:　Aspiration pneumonia is the most important complication of stroke related dysphagia．The aim of this study was to estimate the frequency of pneumonia in stroke patients fed by tube feeding in a rehabilitation hospital and to determine risk factors for this complication．</p><p>Method:　One hundred fifty-eight stroke patients with dysphagia fed by tube feeding admitted to the rehabilitation hospital 1 to 2 months from onset．They were studied retrospectively regarding the frequency and risk factors for the onset of aspiration pneumonia．We divided the subjects into two groups based on the presence or absence of pneumonia during the period of admission．Age，gender，location of disturbance，grading of dysphagia，nutritional status (albumin，total protein，body mass index)，complication and functional independence measure (FIM) on admission were evaluated between the two groups．</p><p>Results:　Twenty-two cases (13.9％) of the 158 stroke patients fed by tube feeding had aspiration pneumonia，which tended to develop among male and older patients compared with the patients without aspiration pneumonia．In the stroke patients with aspiration pneumonia，the location of the disturbance was found to be in the brain stem and cerebellum in 10 (28.6％) of 35 cases．In a logistic regression analysis，the location of disturbance (OR [odds ratio] 4.859，p＝0.01)，grade 1 of dysphagia severity scale (OR 8.747，p＝0.001)，male (OR 5.681，p＝0.006)，and age (OR 0.941，p＝0.043) were significant predictors for the occurrence of aspiration pneumonia in the stroke patients． Albumin values of 50％ of the stroke patients with aspiration pneumonia were moderately to markedly lower than 3.2 g/dL on admission，but nutritional status including albumin was not a significant predictor of it．The stroke patients fed by tube feeding indicated low FIM values on admission．FIM values on admission and complications among stroke patients were not different significantly between the two groups．</p><p>Conclusion:　 Of the stroke patients fed by tube feeding，13.9％ had aspiration pneumonia in the recovery stage in a rehabilitation hospital．Aspiration pneumonia was significantly more common among the stroke patients who were male，of older age，and with the location of disturbance in the brain stem and cerebellum，and who had severe dysphagia compared with those without aspiration pneumonia．</p>

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