重度外傷性脳損傷後の嚥下障害患者に対するエビデンスに基づくバンドルケア：無作為化比較試験

Evidence-based bundled care for patients with dysphagia after severe traumatic brain injury: a randomized controlled trial.

抄録

目的:

重度の外傷性脳損傷（TBI）後の嚥下障害患者において、エビデンスに基づくバンドルケアモデルの効果を検討すること。

OBJECTIVE: To explore the effect of an evidence-based bundled care model in patients with dysphagia after severe traumatic brain injury (TBI).

方法:

本研究は、前向き無作為化対照試験である。リハビリテーション医学科に入院している重度のTBI（外傷性脳損傷）後の嚥下障害患者計60名を抽出し、試験群（n=30）と対照群（n=30）にランダムに分けた。対照群の患者はリハビリテーション医学科で日常的な治療を受け、試験群の患者は対照群の治療をベースにエビデンスに基づいたバンドルケアを受けた。両群において、嚥下機能（昏睡状態の患者における色素検査）、口腔衛生、および栄養リスクの改善が評価されました。誤嚥や誤嚥性肺炎などの有害事象の発生率、および入院期間と費用を両群間で比較した。

METHODS: This is a prospective randomized controlled study. A total of 60 patients with dysphagia after severe TBI (traumatic brain injury) admitted to the Department of Rehabilitation Medicine were selected and randomly divided into the test group (n=30) and the control group (n=30). Patients in the control group received routine care in the Department of Rehabilitation Medicine, while patients in the test group received evidence-based bundled care on the basis of the treatment of the control group. The improvement of swallowing function (dye test in comatose patients), oral hygiene, and nutritional risk was assessed in both groups. The incidence of adverse events such as aspiration and aspiration pneumonia, as well as the length and costs of hospitalization were compared between the two groups.

結果:

対照群の患者と比較して、試験群の患者の嚥下機能はケア後に有意に改善され（P<0.05）、昏睡状態の患者では、エバンスブルー色素検査の陽性率が顕著に低下した（P<0.05）。対照群の患者と比較して、試験群の患者の口腔衛生状態はケア後に有意に改善され、栄養リスクスコアも有意に減少しました（P<0.05）。入院中の有害事象の発生率、入院期間、入院費用の合計は、対照群に比べて試験群の方が有意に低かった（P<0.05）。

RESULTS: Compared with patients in the control group, swallowing function of patients in the test group was significantly improved after the care (P<0.05), and for comatose patients, the positive rate of Evans blue dye test was markedly reduced (P<0.05). Compared with patients in the control group, the oral hygiene of patients in the test group was significantly improved after care, and the nutritional risk scores were also significantly decreased (P<0.05). During hospitalization, the total incidence of adverse events, length and costs of hospitalization of patients in the test group were significantly lower than those in the control group (P<0.05).

結論:

エビデンスに基づくバンドルケアは、重度TBI後の嚥下障害患者の嚥下機能を効果的に改善し、栄養上のリスクや有害事象の発生率を低減することができ、患者の術後リハビリテーションをさらに促進することができる。

CONCLUSION: Evidence-based bundled care can effectively improve swallowing function and reduce the incidence of nutritional risks and adverse events in patients with dysphagia after severe TBI, which further promotes postoperative rehabilitation of patients.